Journal of Pediatric Surgery Open · Published 2026-01-10 · DOI 10.1016/j.yjpso.2026.100261
Objective: To summarize advances in the last decade of care for pectus deformities—primarily pectus excavatum (PE) and pectus carinatum (PC)—with attention to surgical technique, perioperative outcomes, functional and psychosocial effects, and emerging gaps in standardization. Methods: Review of recent clinical studies, consensus statements, and large cohort analyses addressing indications, operative and non-operative management, outcomes, and postoperative protocols. Results: Technique refinements to minimally invasive repair (e.g., multi-bar configurations, bridge fixation, shorter bars, and routine thoracoscopy) have reduced bar displacement and major complications while enabling more complete anterior chest wall remodeling. The modified Ravitch procedure remains an option for adults, complex anatomy, or recurrence, with comparable long-term satisfaction. Non-operative therapies—vacuum bell for selected children and orthotic bracing for PC—achieve good results when initiated early and used consistently. Cardiopulmonary diagnostics increasingly demonstrate postoperative improvements in cardiac output, indices of ventricular performance, and exercise capacity, with pulmonary function changes small or inconsistent. The psychosocial burden of disease is substantial, even in mild deformity, and improves after correction. Enhanced Recovery After Surgery pathways and intercostal nerve cryoablation shorten length of stay, lower opioid exposure, and support same-day discharge in selected programs. Despite progress, indications and preauthorization practices vary widely; reliance on “physiologic” criteria and extensive testing contributes to disparities in access. Conclusions: Contemporary PE/PC care is safer, more effective, and more patient-centered, but remains heterogeneous. Field-wide, consensus-driven guidance that integrates anatomic severity, symptoms, psychosocial distress, and progression would improve equity of access, align payer policy with evidence, and standardize outcomes-oriented care.
Abstract from DOAJ. Public domain (CC0 1.0).
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