A simple method of substernal bar removal after the Nuss procedure

Abstract

The Nuss procedure for pectus excavatum is a well-known technique. Although there are numerous reports on the Nuss procedure, the reports on its removal are few. Removal has been done with many variations in the supine position, which involves bending the bar or bringing the bar beneath the operating table, which can prove to be troublesome and dangerous. Our simple technique allows easy removal of the substernal bar without bar bending. This technique was used in 21 patients without complication.

Minimization of the complications associated with bar removal after the Nuss procedure in adults

“…Most bleeding could be controlled conservatively; however, internal control of bleeding should be considered if massive intrathoracic bleeding occurred. The other common complication after bar removal is wound seroma/hematoma with an incidence rate of approximately 2.36-11.98% [16,18,22]. It can also be from the callus or scar tissues of the wound.…”

“…The CWIG data revealed that more than half of the physicians felt that it was easier to perform surgeries on younger patients. Some modifications of surgical skill for pectus bar removal have been described for reducing the complications [17][18][19][20][21][22][23][24]. Therefore, in this study, we aimed to assess the differences in our modifications on skill and the recent surgical data on pectus bar removal.…”

“…However, there have been successive reports of severe complications, including massive hemothorax and death [10][11][12][13][14][15][16][17][18][19]. Therefore, some physicians suggested improvements to the surgical equipment and methods used for the removal to reduce surgical complications in a recent decade [11,[17][18][19][20][21][22][23][24]. Although some recent studies have discussed the occurrence of these surgical complications, disparate results were reported in large patient cohorts [11,[18][19][20]22].…”

“…Therefore, some physicians suggested improvements to the surgical equipment and methods used for the removal to reduce surgical complications in a recent decade [11,[17][18][19][20][21][22][23][24]. Although some recent studies have discussed the occurrence of these surgical complications, disparate results were reported in large patient cohorts [11,[18][19][20]22]. The statistical data from a large-scale questionnaire survey of physicians from the Chest Wall International Group (CWIG) who have performed such surgeries showed that the incidence of these surgical complications was underestimated and that some severe complications have not been reported [16].…”

Pectus bar removal: surgical technique and strategy to avoid complications

“…Techniques to remove the bar without straightening include using two operating tables in a T-shaped configuration to clear the lateral chest wall (8), or placing the patient in the prone position (9). We find the twotable technique cumbersome and consider the prone position potentially hazardous in the case of incidents such as bleeding or vital organ instability because access to the inside of the chest is difficult.…”