Pectus excavatum: studiously ignored in the United Kingdom?

Pectus excavatum describes a malformation of the anterior chest wall characterised by a hollowing over the sternum and an associated prominence of the costochondral junction. The resulting depression in the chest wall, the opposite situation to pigeon chest (pectus carinatum), is variable in severity, ranging from a mere indentation to an extreme form where the sternum lies within a few centimetres of the vertebral column. The reported incidence is eight per 1000 population, more commonly in boys. It might be anticipated that such a deformity would have significant implications for cardiorespiratory function and pose a cosmetic challenge.

Patients with pectus excavatum have a mild restrictive ventilatory defect,1 but functional impairment is difficult to demonstrate, appearing at only the extreme limit of exercise tolerance.2 Despite an increase in the intrathoracic volume postoperatively, there is no substantial associated improvement in pulmonary function.3

The North American and [continental] European literature abound with references to various aspects of this condition: the possible benefits of surgical treatment, the complications of such operations, and the psychological burden associated with the condition. Such literature reveals that pectus surgery is commonplace in these societies, …