We examined the results for pectus excavatum (PE) repair using conventional methods?sternal elevation by modified Ravitch procedure (SEMR), sternal elevation elevation by metal struts (SEMS), sternal turnover (ST) and costoplasty (CP)?and minimally invasive repair of PE (MIRPE) in 80 patients (65 boys and 15 girls) operated between July 1972 and March 2005 at the First Department of Surgery, Nagasaki University Hospital. Of 80 patients, 23 (28.8%) had asymmetric PE, while 57 (71.2%) had symmetric PE. The medians of cosmetic appearance index, functional impairment index and CT index were 0.022, 0.160 and 5.0395, respectively. A significant (p<0.0001) difference was observed among the operative methods for operating time, blood loss and hospital stay; the median of operating time was 85, 252.5, 145, 170 and 170 min for MIRPE, ST, CP, SEMR and SEMS, respectively; the median of blood loss was 5, 299.5, 243, 105.5 and 547.5 mL for MIRPE, ST, CP, SEMR and SEMS, respectively; the median of hospital stay was 10, 18.5, 30.5, 9.0 and 23.5 days for MIRPE, ST, CP, SEMR and SEMS, respectively. Postoperative complications were noted in 23 patients (28.8%), and the most common complication was wound infections. Epidural analgesia was used for postoperative pain control in 12 (75.0%) of 16 patients receiving MIRPE and 4 (7.7%) of 52 patients receiving ST in 1991 or later. The present study suggests that SEMR and MIRPE will be most versatile methods for children among the 5 operation procedures because of minimum invasion and short hospital stay; MIRPE has advantages that it has no incision of anterior chest wall and that it does not require resection of rib cartilages
