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Pectus bar removal - why, when, where and how.
Frank-Martin Haecker1, Andre Hebra2, Marcelo Martinez Ferro3
1Department of Pediatric Surgery, American Hospital Dubai, Dubai, U.A.E; Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
Pectus bar removal (PBR) after minimally invasive repair of pectus excavatum (MIRPE) is generally safe but can lead to rare, serious complications. Recommendations include careful surgical technique and hospital setting for safe PBR.
Area of Science:
- Thoracic surgery
- Minimally invasive procedures
- Pectus excavatum repair
Background:
- Minimally invasive repair of pectus excavatum (MIRPE) is a common procedure.
- Pectus bar removal (PBR) is often considered routine.
- Serious complications have been reported for both MIRPE and PBR.
Observation:
- A literature review focused on PBR complications after MIRPE.
- Searched articles published since 1998 using terms like "Pectus bar removal" and "near-fatal complications".
- Included case studies, case reports, and reviews.
Findings:
- PBR has a high safety profile but rare, severe complications like life-threatening hemorrhage can occur.
- Patients with a history of complex MIRPE face a higher risk.
- Complications are more likely with certain surgical techniques.
Implications:
- Recommendations for safe PBR include bilateral incisions, bar unbending, and meticulous mobilization.
- PBR should be performed in a hospital with cardiac surgery support.
- Same-day discharge is feasible if the postoperative course is uneventful.
