Application of cross bar technique in repair of pectus excavatum_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Tianjun , TIAN Dan , SHI Ruiqing , ZHOU Zihao , TANG Jiming , ZHANG Dongkun , BEN Xiaosong , QIAO Guibin , CHEN Gang ,  XIE Liang

Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China;

Corresponding author：

XIE Liang, Email: xierobert@21cn.com

Keywords：

Pectus excavatum; Nuss procedure; cross bar technique; rib flare

DOI：

10.7507/1007-4848.202409028

Video：

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Objective To explore the indication, surgical technique, and clinical efficacy of the cross bar procedure in pectus excavatum. Methods The clinical data of patients who underwent cross bar procedure from August 2023 to August 2024 in Guangdong Provincial People's Hospital were retrospectively analyzed. Results A total of 88 patients including 85 males and 3 females with a mean age of (17.56±5.20) years were enrolled. All operations were performed successfully without intraoperative cardiac injury, pericardial injury or diaphragmatic injury. The mean operation time was (147.65±47.75) min. The mean blood loss was (13.30±9.06) mL. The mean postoperative hospitalization stay was (4.81±1.55) days, without perioperative death. Six (6.82%) patients developed early postoperative complications, including 3 patients of pleural effusion, 1 patient of subcutaneous hematoma, 1 patient of suffocation and 1 patient of bar rotation. The postoperative outcomes were excellent in 71 (80.68%) patients, good in 16 (18.18%) patients and moderate in 1 (1.13%) patient. Conclusion The cross bar technique is safe and convenient, with satisfactory results. It is worth promoting in clinical application.

1.	Park HJ, Lee SY, Lee CS, et al. The Nuss procedure for pectus excavatum: Evolution of techniques and early results on 322 patients. Ann Thorac Surg, 2004, 77(1): 289-295.
2.	Hyun K, Park HJ. The cross-bar technique for pectus excavatum repair: A key element for remodeling of the entire chest wall. Eur J Pediatr Surg, 2023, 33(4): 310-318.
3.	Park HJ, Rim G, Yoon SK. Recent advancements in pectus surgery: Crane lifting, multiple-bar approach, bridge stabilization, and sandwich technique. J Pediatr Surg, 2024, 59(4): 640-647.
4.	Ermerak NO, Yuksel M. Modification of the Nuss procedure: The crossed bar technique for new subtypes of pectus excavatum. Gen Thorac Cardiovasc Surg, 2023, 71(10): 577-583.
5.	Nuss D, Obermeyer RJ, Kelly RE. Pectus excavatum from a pediatric surgeon's perspective. Ann Cardiothorac Surg, 2016, 5(5): 493-500.
6.	Nuss D, Kelly RE. Indications and technique of Nuss procedure for pectus excavatum. Thorac Surg Clin, 2010, 20(4): 583-597.
7.	Ersöz H, Karaali R, Kuzmichev V, et al. Evaluation of cross-bar and parallel-bar techniques in MIRPE surgery in different countries: A multicenter study. Updates Surg, 2024, 76(4): 1501-1509.
8.	谢亮, 陈刚, 唐继鸣, 等. Nuss手术矫治复杂漏斗胸95例. 中华胸心血管外科杂志, 2011, 27(11): 648-650.Xie L, Chen G, Tang JM, et al. The Nuss procedure for complicated pectus excavatum. Chin J Thorac Cardiovasc Surg, 2011, 27(11): 648-650.
9.	曾骐, 段贤伦, 张娜, 等. 大年龄组漏斗胸的微创Nuss手术. 中华胸心血管外科杂志, 2007, 23(3): 193-195.Zeng Q, Duan XL, Zhang N, et al. Nuss procedure for the correction of pectus excavatumin elder group. Chin J Thorac Cardiovasc Surg, 2007, 23(3): 193-195.
10.	Kim MW, Jeong JY, Ha G, et al. Brachial plexus palsy after Nuss procedure for pectus excavatum. Turk Gogus Kalp Damar Cerrahisi Derg, 2019, 27(2): 245-247.
11.	王磊, 胡丰庆, 王明松, 等. 漏斗胸的手术设计与新型改良Nuss手术. 中国胸心血管外科临床杂志, 2020, 27(8): 900-906.Wang L, Hu FQ, Wang MS, et al. Surgical design and novel modified Nuss procedure for pectus excavatum. Chin J Thorac Cardiovasc Surg, 2020, 27(8): 900-906.
12.	Nuss D, Kelly RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
13.	Darlong LM. Single-centre Indian case series using X or cross bar for Nuss procedure in pectus excavatum. Indian J Thorac Cardiovasc Surg, 2020, 36(6): 643-648.
14.	Pilegaard HK. Nuss technique in pectus excavatum: A mono-institutional experience. J Thorac Dis, 2015, 7(Suppl 2): S172-S176.
15.	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(5): 526-527.
16.	曾骐, 陈诚豪. 对如何全面、安全、细致开展微创胸壁矫形手术的思考. 临床小儿外科杂志, 2023, 22(6): 501-505.Zeng Q, Chen CH. Mini-invasive repairing chest wall deformity comprehensively, safely and meticulously. J Clin Pediatr Surg, 2023, 22(6): 501-505.
17.	Moon DH, Park CH, Moon MH, et al. The effectiveness of double-bar correction for pectus excavatum: A comparison between the parallel bar and cross-bar techniques. PLoS One, 2020, 15(9): e0238539.
18.	陶绍霖, 康珀铭, 冯涌耕, 等. 胸腔镜辅助改良Nuss手术治疗儿童漏斗胸临床疗效的单中心回顾性分析. 中国胸心血管外科临床杂志, 2023, 30(6): 867-872.Tao SL, Kang PM, Feng YG, et al. Clinical efficacy of thoracoscopy-assisted modified Nuss procedure in children with pectus excavatum: A retrospective analysis in a single center. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(6): 867-872.
19.	Kelly RE, Obermeyer RJ, Goretsky MJ, et al. Recent modifications of the Nuss procedure: The pursuit of safety during the minimally invasive repair of pectus excavatum. Ann Surg, 2022, 275(2): e496-e502.
20.	Kim H, Rim G, Park HJ. Technical advances in pectus bar stabilization in chest wall deformity surgery: 10-year trends and an appraisal with 1, 500 patients. J Chest Surg, 2023, 56(4): 229-237.

1. Park HJ, Lee SY, Lee CS, et al. The Nuss procedure for pectus excavatum: Evolution of techniques and early results on 322 patients. Ann Thorac Surg, 2004, 77(1): 289-295.
2. Hyun K, Park HJ. The cross-bar technique for pectus excavatum repair: A key element for remodeling of the entire chest wall. Eur J Pediatr Surg, 2023, 33(4): 310-318.
3. Park HJ, Rim G, Yoon SK. Recent advancements in pectus surgery: Crane lifting, multiple-bar approach, bridge stabilization, and sandwich technique. J Pediatr Surg, 2024, 59(4): 640-647.
4. Ermerak NO, Yuksel M. Modification of the Nuss procedure: The crossed bar technique for new subtypes of pectus excavatum. Gen Thorac Cardiovasc Surg, 2023, 71(10): 577-583.
5. Nuss D, Obermeyer RJ, Kelly RE. Pectus excavatum from a pediatric surgeon's perspective. Ann Cardiothorac Surg, 2016, 5(5): 493-500.
6. Nuss D, Kelly RE. Indications and technique of Nuss procedure for pectus excavatum. Thorac Surg Clin, 2010, 20(4): 583-597.
7. Ersöz H, Karaali R, Kuzmichev V, et al. Evaluation of cross-bar and parallel-bar techniques in MIRPE surgery in different countries: A multicenter study. Updates Surg, 2024, 76(4): 1501-1509.
8. 谢亮, 陈刚, 唐继鸣, 等. Nuss手术矫治复杂漏斗胸95例. 中华胸心血管外科杂志, 2011, 27(11): 648-650.Xie L, Chen G, Tang JM, et al. The Nuss procedure for complicated pectus excavatum. Chin J Thorac Cardiovasc Surg, 2011, 27(11): 648-650.
9. 曾骐, 段贤伦, 张娜, 等. 大年龄组漏斗胸的微创Nuss手术. 中华胸心血管外科杂志, 2007, 23(3): 193-195.Zeng Q, Duan XL, Zhang N, et al. Nuss procedure for the correction of pectus excavatumin elder group. Chin J Thorac Cardiovasc Surg, 2007, 23(3): 193-195.
10. Kim MW, Jeong JY, Ha G, et al. Brachial plexus palsy after Nuss procedure for pectus excavatum. Turk Gogus Kalp Damar Cerrahisi Derg, 2019, 27(2): 245-247.
11. 王磊, 胡丰庆, 王明松, 等. 漏斗胸的手术设计与新型改良Nuss手术. 中国胸心血管外科临床杂志, 2020, 27(8): 900-906.Wang L, Hu FQ, Wang MS, et al. Surgical design and novel modified Nuss procedure for pectus excavatum. Chin J Thorac Cardiovasc Surg, 2020, 27(8): 900-906.
12. Nuss D, Kelly RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
13. Darlong LM. Single-centre Indian case series using X or cross bar for Nuss procedure in pectus excavatum. Indian J Thorac Cardiovasc Surg, 2020, 36(6): 643-648.
14. Pilegaard HK. Nuss technique in pectus excavatum: A mono-institutional experience. J Thorac Dis, 2015, 7(Suppl 2): S172-S176.
15. 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(5): 526-527.
16. 曾骐, 陈诚豪. 对如何全面、安全、细致开展微创胸壁矫形手术的思考. 临床小儿外科杂志, 2023, 22(6): 501-505.Zeng Q, Chen CH. Mini-invasive repairing chest wall deformity comprehensively, safely and meticulously. J Clin Pediatr Surg, 2023, 22(6): 501-505.
17. Moon DH, Park CH, Moon MH, et al. The effectiveness of double-bar correction for pectus excavatum: A comparison between the parallel bar and cross-bar techniques. PLoS One, 2020, 15(9): e0238539.
18. 陶绍霖, 康珀铭, 冯涌耕, 等. 胸腔镜辅助改良Nuss手术治疗儿童漏斗胸临床疗效的单中心回顾性分析. 中国胸心血管外科临床杂志, 2023, 30(6): 867-872.Tao SL, Kang PM, Feng YG, et al. Clinical efficacy of thoracoscopy-assisted modified Nuss procedure in children with pectus excavatum: A retrospective analysis in a single center. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(6): 867-872.
19. Kelly RE, Obermeyer RJ, Goretsky MJ, et al. Recent modifications of the Nuss procedure: The pursuit of safety during the minimally invasive repair of pectus excavatum. Ann Surg, 2022, 275(2): e496-e502.
20. Kim H, Rim G, Park HJ. Technical advances in pectus bar stabilization in chest wall deformity surgery: 10-year trends and an appraisal with 1, 500 patients. J Chest Surg, 2023, 56(4): 229-237.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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