Selective subxiphoid incision during MIRPE: Indications and outcomes

Abstract

Objective: This study assessed the utility of a selective subxiphoid incision during minimally invasive repair of pectus excavatum (MIRPE), emphasizing indications and early outcomes in patients at increased surgical risk. Patients and Methods: Data from 39 patients were retrospectively analyzed, all of whom underwent MIRPE with an additional subxiphoid incision between August 2007 and May 2025. Data included demographics, deformity characteristics, surgical history, operative details, hospital stay, complications, and bar removal status. Results: The mean age was 22.2 years (range 7–55), and 84.6% were male. The deformity was symmetric in 22 patients and asymmetric in 17. Indications for a subxiphoid incision included previous Ravitch (n=13) or MIRPE (n=14), severe pleural adhesions (n=6), prior sternotomy (n=2), and severe deformity (n=4). One bar was used in 25 patients, two in 11, three in 2, and four in 1. Mean operative time was 84.6 minutes, and mean hospital stay was 4.2 days. No intraoperative cardiac or pericardial injury occurred. Complications occurred in four patients (two wound revisions, two bar revisions). Bar removal was completed in 25 patients. Conclusion: Adding a subxiphoid incision during MIRPE provides controlled retrosternal dissection and enhances safety in selected high-risk cases, particularly redo procedures and severe deformities.

Keywords

• Pectus excavatum
• MIRPE
• Thoracoscopy
• Subxiphoid approach

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