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J Thorac Cardiovasc Surg 2007;134:871-876
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Valuable lessons from two decades of pectus repair with the Willital–Hegemann procedure

^a Department of Pediatric Surgery, Medical University of Graz, Graz, Austria
^b Pediatric Surgical University Clinic, Münster, Germany.

Received for publication January 22, 2007; revisions received June 12, 2007; accepted for publication June 15, 2007.

^_* Address for reprints: Amulya K. Saxena, MD, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz-34, A-8036 Graz, Austria. (Email: amulya.saxena{at}meduni-graz.at).

Objective: Pectus deformities are the most common congenital hereditary chest wall deformity. The aim of this study was to evaluate the efficacy of thoracic wall reconstruction using a uniform technique of internal stabilization with stainless-steel struts.

Methods: Hospital charts of patients with chest wall deformities managed with the Willital–Hegemann procedure between January 1984 and January 2004 were reviewed.

Results: Surgical corrections were performed in 1262 patients with pectus deformities (968 male and 294 female patients). The corrections were completed with successful repair in 1244 (98.6%) patients, along with a low complication rate of 5.7%. The median age of the patients was 14.9 years (range, 2–53 years). The follow-up period ranged from 2 to 12 years (mean, 5.4 years). Major recurrences were observed in 18 (1.4%) patients, and mild recurrences were observed in 46 (3.6%) patients. There was 1 death in this series. The struts were removed after a period of 24 to 36 months and were associated with a complication rate of 2.6% at the time of removal.

Conclusion: Custom-tailored molding of the chest wall can be achieved by using this method, which is not possible with minimal-access techniques. Open repair is effective for all variations of chest wall deformities and in patients of all ages, causes only mild pain, and produces good physiologic and cosmetic results. Improvement of subjective complaints, satisfactory long-term results, and improvement in psychological problems indicate the need to offer this procedure among other surgical correction options for low-risk children.