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To summarize the clinical experience with a new open repair for pectus excavatum (PE), with minimal cartilage resection.A wide variety of modified techniques of the Ravitch repair for PE have been used over the past 5 decades, with the complications and results being inconsistent. Extensive subperiosteal costal cartilage resection and perichondrial sheath detachment from the sternum may not be necessary for optimal repair.During a 12-month period, 75 consecutive patients with symptomatic PE underwent open repair using a new less invasive technique. After exposing the deformed costal cartilages, a short chip was resected medially adjacent to the sternum and laterally at the level where the chest had a near normal contour, allowing the cartilage to be elevated to the desired level with minimal force. A transverse anterior sternal osteotomy was used on most patients. A substernal support strut was used for 66 patients; the strut was placed anterior to the sternum in 9 patients under age 12 and over age 40 years. The strut was routinely removed within 6 months.With a mean follow-up of 8.2 months, all but 1 patient regarded the results as very good or excellent. Mean operating time was 174 minutes; mean hospitalization was 2.7 days. There were no major complications or deaths.The open repair using minimal cartilage resection is effective for all variations of PE in patients of all ages, uses short operating time, provides a stable early postoperative chest wall, causes only mild postoperative pain, and produces good physiologic and cosmetic results.