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

Crane-powered pectus excavatum repair: the NeoPectus surgery

“…The use of pectus bars was distributed as follows: single bar in 30.5% (211) of cases, and multiple bars in 69.5% (480) of cases. Types of bar placement included single bar in 30.5% (211) of cases, parallel bars in 22.0% (152) of cases, and cross bars or cross plus horizontal bars (XI) in 47.5% (328) of cases ( 12 , 13 ). Pectus bar stabilization techniques involved the use of a claw fixators for single bar cases in 30.5% (211) and bridge stabilization for multiple bars in 69.5% (480) of cases ( 14 , 15 ).…”

The management of pectus excavatum in pediatric patients: a narrative review

“…The two bars are inserted diagonally, cross in the center, and are attached using bridge fixation to prevent rotation ( 43 ). The same group recently published a series comparing cross-bar and parallel-bar techniques among 247 patients and demonstrated the cross-bar technique to be as safe and effective as parallel bar with no difference in complication rates despite patients in the cross-bar group overall being older with a higher depression index, and generally with more rigid and complex pectus defects ( 44 ).…”

Technical Advances in Pectus Bar Stabilization in Chest Wall Deformity Surgery: 10-Year Trends and an Appraisal with 1,500 Patients

“…Lastly, there is a trend of increasingly using the multiple-bar approach for entire chest wall remodeling [17]. At the beginning of the Nuss approach, only a single bar was utilized, as the extent of chest wall coverage was not a consideration-instead, the aim was simply to lift the chest wall to relieve cardiac compression.…”

“…To address this issue, we began multiple-bar repair (the parallel-bar technique) and expanded the scope of treatment [18]. Moreover, in pursuit of the highest anatomical and physiological integrity of the chest wall, we developed the cross bar (the cross-bar technique) and the cross bar plus upper bar approach (the XI technique), which allowed us to apply the entire chest wall remodeling principle [17]. Moreover, as the final touches for anatomically correct repair, we freely utilized the sandwich technique and its variants: the flare-buster technique for alleviating the lower costal flares and the magic string technique to compress focal chest wall protrusions [11,19,20].…”