Dramatic procedural results for pectus excavatum patients

Dec 1 2008

Patients who have had the common chest wall deformity known as pectus excavatum corrected report improved body image and ability to exercise, according to a study published December in the journal Pediatrics.

The study, conducted at 11 North American hospitals, involved telephone interviews of more than 200 patients between the ages of 8 and 21 who had pectus excavatum surgery. Researchers interviewed parents as well.

The results were dramatic. Patients reported greatly improved body image and marked decrease in problems with exercise.

"These results should prompt physicians to consider both the emotional and physical implications of correcting pectus excavatum," said lead author Robert Kelly, M.D., a pediatric surgeon at Children's Hospital of The King's Daughters and Professor of Clinical Surgery and Pediatrics at Eastern Virginia Medical School in Norfolk, Va. "For too long, many in the medical community dismissed pectus excavatum as a merely cosmetic issue, but correcting pectus excavatum has concrete physical and psychological benefits."

Pectus excavatum is the most common congenital deformity of the chest wall. Its defining feature is a depression, or indentation of the chest wall.

In the late 1980s, King's Daughters surgeon Donald Nuss developed a minimally invasive technique to correct pectus excavatum that has since been widely adopted. King's Daughters remains a major training site for surgeons and a center for research on chest wall deformities.

"In Norfolk, we've performed the Nuss Procedure on more than 1,000 patients," says Kelly. "Having such a large population of patients helped us detect a trend. In patient after patient, it was as if surgery turned a light on inside. They seemed much more confident and outgoing after surgery than they did before."

After hearing similar anecdotal evidence from other facilities, surgeons enlisted the help of psychologist Thomas Cash, Ph.D., one of the nation's top researchers on body image issues, to help design a study that would determine whether the trend surgeons noted would hold up to scientific scrutiny.

Other hospitals participating in the study were: All Children's Hospital, St. Petersburg, Fla.; Boston Children's Hospital; Children's Hospital of Wisconsin, Milwaukee, Wisc.; Children's Medical Center, Dallas, Tx.; Children's Mercy Hospital, Kansas City, Mo.; Cincinnati Children's Hospital Medical Center; Hospital for Sick Children, Toronto, Canada; Johns Hopkins University Medical Center, Baltimore, Md; Kapi'olani Medical Center for Women and Children, Honolulu, Hi; and Yale New Haven Children's Hospital.

The survey, which was conducted before and one year after surgery, asked parents how often children with pectus excavatum were irritable, frustrated or depressed and whether they were reluctant to be seen without a shirt or in a bathing suit before surgery.

Patients answered similar questions.

Both patients and parents also answered questions about whether the patient suffered pain or shortness of breath when exercising.

Patients and parents reported striking improvements psychologically and physically.

"One of the most interesting things we discovered was that there was not a direct correlation between the severity of the defect and the degree of improvement in body image," said Kelly. "Even patients with mild deformities experienced significant improvement in body image.

Although the study didn't focus on specific physical activities, it asked both patients and parents how often the pectus excavatum caused pre-surgery patients to have "trouble" exercising and being physically active.

The results showed a stunning improvement, with the physical difficulties score falling between "often" and "very often" before surgery and falling between "sometimes" and "never" after surgery.

Cash also believes the body image of the child may play a role in increased participation in athletics.

"Pectus excavatum leads many kids to avoid physical activities that would make their 'different looking' bodies evident to others," Cash said. "The surgery that remedies this 'difference' can improve their subjective body image, free them of this inhibition and permit them to do active things that may enhance their physical abilities and their sense of personal and social acceptability."

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