Contemporary management of recurrent pectus excavatum

Maria Grazia Sacco Casamassima, Dominic Papandria, Seth D. Goldstein, Jingyan Yang, Kimberly H. McIltrot, Fizan Abdullah, Paul M. Colombani

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Optimal management of recurrent pectus excavatum (PE) has not been established. Here, we review our institutional experience in managing recurrent PE to evaluate long-term outcomes and propose an anatomic classification of recurrences, and a decision-making algorithm. Methods: Clinical records of patients undergoing repair of recurrent PE (1996–2011) were reviewed. Univariate and multivariate logistic regression analyses were employed to examine patient characteristics as potential predictors for re-recurrence. Results: Eighty-five patients with recurrent PE were identified during the study period. The initial operation was a Ravitch procedure in 85% of cases. Revision procedures were most frequently Nuss repairs (N = 73, 86%), with remaining cases managed via open approach. Overall cosmetic and functional results were satisfactory in 67 patients (91.8%) managed with Nuss and in 7 (58%) patients managed with other techniques. Seven (8%) patients required additional surgical revision. Multivariate analysis identified no statistically significant patient or procedural factors predictive of re-recurrence. Conclusion: This study demonstrates that the Nuss procedure can be an effective intervention for recurrent pectus excavatum, regardless of the initial repair technique. However, open repair remains valuable when managing severe cases with abnormalities of the sternocostal junction and cartilage regrowth under the sternum.

Original languageEnglish (US)
Pages (from-to)1726-1733
Number of pages8
JournalJournal of pediatric surgery
Issue number10
StatePublished - Oct 2015


  • Floating sternum
  • Pectus excavatum
  • Recurrent chest wall deformity

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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