A simple technique for preventing bar displacement with the Nuss repair ofpectus excavatum

Background/Purpose: The most common complication of the minimally invasive technique for repair of pectus excavatum (MIRPE) is bar displacement, which has been reported to occur in 9.5% of all cases, particularly in teenaged patients. The use of a lateral stabilizing bar has improved stability but h as not eliminated the occurrence of this problem. The authors report a new technique added to the standard MIRPE that creates an additional third poin t of fixation of the pectus bar to prevent displacement. Methods: The technique requires the simple placement, via a spinal needle, of a nonabsorbable suture next to the sternum, encircling a rib and the bar , using a single 3-mm stab wound and thoracoscopic guidance. The suture sim ply is buried under the skin. Since 1998, this technique has been applied t o 20 patients who underwent MIRPE. Results: The average age was 14 years; 80% were boys. Average operating tim e was 75 minutes, and all patients had thoracoscopy with the MIRPE. A later al stabilizing bar also was used in 14 patients. Four patients had 2 struts placed. Average length of stay was 5.5 days. There were no early complicat ions. Mean follow-up was 12 months. Bar displacement occurred in 1 patient early in the series in which an absorbable suture was used for fixation. On e patient had a prolonged hospital stay of 7 days because of postoperative pain. Conclusions: This modification to the original technique of MIRPE creates a 3-point fixation system that minimizes the risk of bar shifting even in te enaged patients. It does not add any significant time or cost to the operat ion, and it is fairly simple to perform. The authors believe that this tech nique decreases the occurrence of bar displacement, and they recommend its use for all patients with pectus excavatum considered candidates for the Nu ss repair. J Pediatr Surg 36:1266-1268. Copyright (C) 2001 by W.B. Saunders Company.