Dr. Eric Fonkalsrud, professor of surgery and emeritus chief of pediatric surgery at the David Geffen School of Medicine at UCLA, has reached a surgical milestone by performing his 1,000th pectus repair surgery.

Fonkalsrud, age 73, is a pioneer is the field of a surgery to correct pectus excavatum - commonly known as funnel or sunken chest syndrome - and pectus carinatum - also called pigeon or chicken breast - in which the chest cavity is pushed outward.

Although he has performed more than 14,000 various operations during his career, pectus repair surgeries have been his favorite for many years.

"From all of the different operative procedures, I have never observed one particular type of surgery where the patient and the family were more satisfied with the results," Fonkalsrud said.

"I am so glad that Dr. Fonkalsrud was able to help me," said 13-year-old Jordan Davenport, the surgeon's 1,000th pectus patient.

In fact, Davenport bragged that the surgery went so well he never had to take any prescription pain relievers upon his release from the hospital. He is already back at school after his Nov. 8 surgery. Davenport's case was so severe that despite being 5 feet 9 inches tall, his sternum was a mere 3.1 centimeters from his spine, drastically reducing the capacity of his chest cavity.

"I already feel that I can breathe better and it doesn't hurt to eat any more," he said.

Fonkalsrud started performing the surgery in the 1950s during his residency at Johns Hopkins University Medical School under the direction of Dr. Mark Ravitch, who was one of the earliest surgeons to develop a technique for repair of pectus deformities in 1949. Over the years, Fonkalsrud has refined the procedure and developed his own techniques. Today, the procedure results in minimal pain for the patient, fewer complications, a faster recovery period and better long-term results.

In addition to improvements in technique, Fonkalsrud has noticed other trends with the surgery.

In the early years, patients were usually under eight years of age at the time of the repair. However, because children this young were rarely symptomatic and the rib cage was very immature, it later was determined that it was better to wait until the child grew to adolescence in order to reduce the frequency of recurrent deformity.

The Internet launched another trend. With a wealth of information available on the World Wide Web, people finally could find extensive information regarding the symptoms associated with pectus deformities, the various surgical options and the results.

In a study published in the September 2002 issue of Annals of Surgery, Fonkalsrud noted that with the surge of information about pectus excavatum and pectus carinatum on the Internet, patients were becoming even older as people finally gained widespread access to information about the minimally invasive surgical repair.

"More than ever, we began to see adults - even in their 60s - who never received treatment during their childhood, usually because they were told that surgical repair was dangerous and minimally effective," Fonkalsrud said.

Since the surgery is not widely available, more than half of his patients have traveled to UCLA from all over the United States and nine foreign countries including Australia, Germany, South Africa, Portugal and Sweden.

Although he officially retired in 2000, the grandfather of four continues to work part-time because he enjoys the opportunity to perform this one basic operation and to work with the staff. With approximately 100 patients annually, he plans to keep doing the surgery for another year or two.

In addition, he and his UCLA colleague Dr. Christopher Cooper, professor of pulmonology, have received support from the March of Dimes to study the physiological effects of chest wall deformities. Data shows that many patients who do not undergo repair of severe pectus chest defects during childhood will experience worsening symptoms in adult life, including shortness of breath with mild exercise, progressive loss of stamina and endurance with physical activity, and heart palpitations.

Pectus excavatum is by far the most common major congenital chest deformity - occurring in approximately one in every 400 white male babies. Pectus malformations are five times less frequent in females.

The majority of patients with pectus excavatum are diagnosed during the first year of life. Inward depression usually becomes much more severe during the period of rapid skeletal growth in early adolescence. With pectus carinatum, deformities are often unrecognized until adolescent skeletal growth occurs. The majority of both types of deformities remain with the same severity throughout adult life after bone maturity has been achieved.

The surgical repair takes an average of three hours. Patients remain hospitalized for about three days and return to work or school within two weeks. A sternal support bar, implanted during surgery, is removed about 6 months later in an outpatient surgical procedure that takes less than 20 minutes.

Fonkalsrud plans to celebrate his 1,000th pectus repair surgery at an upcoming reception where he will thank his fellow doctors, nurses and staff who helped him reach this remarkable milestone.

-UCLA-
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