Surgical treatment of postoperative syndromes in children after surgery for pectus excavatum

Objective. To develop the methods of surgical correction of postoperative syndromes in children after previous surgery for pectus excavatum. Material and methods. The study included 600 pediatric patients after previous surgery for pectus excavatum. There were different postoperative periods: 1 year — 129 (21.5%) cases, 3 years — 146 (24.3%) cases, 5 years — 158 (26.3%) cases, over 5 years (after removal of fixator) — 167 (27.9%) cases. Different postoperative syndromes occurred in 40 (6.7%) cases. We analyzed children considering postoperative syndromes throughout 5-year postoperative period. Three (0.5%) patients had pectus excavatum recurrence grade II and III, 8 (1.3%) patients — syndrome of atypical sternum protrusion, 25 (4.2%) patients — syndrome of abnormal sternum rotation over 15°, 4 (0.65%) patients — syndrome of atypical rib retraction where the ends of the sternocostal plate were observed. Sternochondroplasty was performed in 3 (0.5%) patients with pectus excavatum recurrence grade II and III. Eight (1.3%) patients with atypical sternum protrusion were scheduled for various wedge-shaped resections of the sternum and chondrotomy or local resection of cartilaginous parts of the ribs. Twenty-five (4.2%) patients with syndrome of abnormal sternum rotation over 15° required unilateral hemisternotomy and ipsilateral resection of cartilaginous parts of the ribs. Conclusion. Clinically diverse postoperative syndromes require differentiating them from each other to develop specific indications for surgical treatment. Wedge-shaped resection of the sternum is advisable for atypical protruding deformities of anterior chest wall. Hemisternotomy with cartilage resections and chondrotomy are preferred for abnormal sternum rotation. Sternochondroplasty is advisable for pectus excavatum recurrence.