The Cross-Bar Technique for Pectus Excavatum Repair: A Key Element for Remodeling of the Entire Chest Wall

Abstract

Introduction The multiple bar approach was developed to cover broader and heavier teenager/adult chest wall deformities. We designed the cross-bar technique to achieve remodeling of the entire chest wall. This study aimed to demonstrate the role of cross-bar and its benefits over the parallel bar.

Materials and Methods The cross-bar technique involves placing two bars diagonally and then cross on the target. The primary purposes are to double the lifting forces by making two bars converge on a single target to lift inflexible heavy chest wall depressions or cover lower lateral areas. The results of the cross-bar and parallel bar are compared for the indications, postrepair outcomes, and complications.

Results From 2016 to 2019, 247 patients who underwent multiple bar pectus excavatum (PE) repair were enrolled in the study: 157 with cross-bar and 90 with parallel bar. In the cross-bar group, 33% (51/157) received three bars in XI fashion to cover the upper depression. The cross-bar group was older (18.0 ± 6.1 vs. 15.7 ± 5.0), had higher depression index (1.9 ± 0.7 vs. 1.8 ± 0.3), and was less asymmetric (45% vs. 71%) than those in the parallel bar group. The overall complication rates were not different between the two groups (9.6% vs. 10%, p = 1.0), although the cross-bar group was more rigid and complex. There was no bar displacement or reoperation in both groups.

Conclusion The cross-bar technique is as safe and effective as the parallel-bar technique, even though it was selected to correct more complexities. The cross-bar technique could be a method for complex PE deformities for remodeling of the entire chest wall.

Keywords

pectus excavatum - minimally invasive repair - cross-bar technique - parallel-bar technique

Publikationsverlauf

Eingereicht: 03. April 2022

Angenommen: 07. Juli 2022

Accepted Manuscript online:
12. Juli 2022

Artikel online veröffentlicht:
21. Oktober 2022

• References

• 1 Jaroszewski DE, Ewais MM, Chao CJ. et al. Success of minimally invasive pectus excavatum procedures (modified Nuss) in adult patients (≥30 years). Ann Thorac Surg 2016; 102 (03) 993-1003
• 2 Park HJ, Lee SY, Lee CS, Youm W, Lee KR. The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. Ann Thorac Surg 2004; 77 (01) 289-295
• 3 Pawlak K, Gąsiorowski Ł, Gabryel P, Gałęcki B, Zieliński P, Dyszkiewicz W. Early and late results of the Nuss procedure in surgical treatment of pectus excavatum in different age groups. Ann Thorac Surg 2016; 102 (05) 1711-1716
• 4 Nuss D, Kelly Jr RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998; 33 (04) 545-552
• 5 Park HJ. Technical innovations in the minimally invasive approach for treating pectus excavatum: a paradigm shift through six years' experience with 630 patients. Innovations (Phila) 2007; 2 (01) 25-28
• 6 Park HJ, Jeong JY, Jo WM. et al. Minimally invasive repair of pectus excavatum: a novel morphology-tailored, patient-specific approach. J Thorac Cardiovasc Surg 2010; 139 (02) 379-386
• 7 Park HJ. A technique for complex pectus excavatum repair: the cross-bar technique for Grand Canyon type deformity (Park classification). Ann Cardiothorac Surg 2016; 5 (05) 526-527
• 8 Park HJ, Kim KS, Moon YK, Lee S. The bridge technique for pectus bar fixation: a method to make the bar un-rotatable. J Pediatr Surg 2015; 50 (08) 1320-1322
• 9 Moon DH, Park CH, Moon MH, Park HJ, Lee S. The effectiveness of double-bar correction for pectus excavatum: a comparison between the parallel bar and cross-bar techniques. PLoS One 2020; 15 (09) e0238539
• 10 Park HJ, Kim KS. The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex. Ann Cardiothorac Surg 2016; 5 (05) 434-439
• 11 Messineo A, Ghionzoli M, Lo Piccolo R, Milanez De Campos JR. A simplified method to pass the bar through the mediastinum in the Nuss technique. Ann Thorac Surg 2015; 99 (02) 717-718
• 12 Croitoru DP, Kelly Jr RE, Goretsky MJ, Lawson ML, Swoveland B, Nuss D. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg 2002; 37 (03) 437-445
• 13 Park HJ, Lee IS, Kim KT. Extreme eccentric canal type pectus excavatum: morphological study and repair techniques. Eur J Cardiothorac Surg 2008; 34 (01) 150-154
• 14 Hebra A, Jacobs JP, Feliz A, Arenas J, Moore CB, Larson S. Minimally invasive repair of pectus excavatum in adult patients. Am Surg 2006; 72 (09) 837-842
• 15 Lo PC, Tzeng IS, Hsieh MS, Yang MC, Wei BC, Cheng YL. The Nuss procedure for pectus excavatum: an effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients. PLoS One 2020; 15 (05) e0233547
• 16 Pilegaard HK. Nuss technique in pectus excavatum: a mono-institutional experience. J Thorac Dis 2015; 7 (Suppl. 02) S172-S176
• 17 Castellani C, Schalamon J, Saxena AK, Höellwarth ME. Early complications of the Nuss procedure for pectus excavatum: a prospective study. Pediatr Surg Int 2008; 24 (06) 659-666
• 18 Yoo G, Shin J, Rha EY. et al. Quadrangular fixation of pectus bars to prevent displacement in Nuss procedure. Thorac Cardiovasc Surg 2020; 68 (01) 80-84
• 19 Obermeyer RJ, Godbout E, Goretsky MJ. et al. Risk factors and management of Nuss bar infections in 1717 patients over 25 years. J Pediatr Surg 2016; 51 (01) 154-158