Pectus Carinatum Repair Using the Sandwiched Bars and Screw Fixation System: A Retrospective Cohort Study of a Single
Tran Thanh Vy1,2, Ho Tat Bang1,3, Ha Quoc Hung4
1Thoracic and Vascular Department, University Medical Center Ho Chi Minh City University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam.
Insights
The sandwiched bar and screw fixation system effectively treats pectus carinatum (PC), a chest wall deformity. This minimally invasive approach demonstrated high success rates and safety in a Vietnamese cohort.
Area of Science:
- Thoracic Surgery
- Pediatric Surgery
- Surgical Innovation
Background:
- Pectus carinatum (PC) is a common anterior chest wall deformity impacting body image and quality of life.
- Minimally invasive surgical techniques are increasingly explored for PC correction.
- The sandwiched bar and screw fixation system represents a novel approach for PC treatment.
Purpose of the Study:
- To evaluate the safety and effectiveness of the sandwiched bar and screw fixation system for PC treatment.
- To identify factors influencing postoperative outcomes in PC patients.
- To report the initial experience with this technique in Vietnam.
Main Methods:
- Retrospective cohort study of 39 PC and mixed PC-PE patients from March 2016 to February 2023.
- Surgical correction using the sandwiched bar and screw fixation system.
- Analysis of demographic data, operative time, hospital stay, Haller Index (HI), and complications; multivariate regression identified outcome predictors.
Main Results:
- The mean operative time was 68.1 minutes, with a 5.3-day hospital stay.
- Significant improvement in Haller Index (HI) from 1.96 to 2.49 (p < 0.001).
- 97.4% of patients achieved good outcomes with no serious complications; asymmetry and sternal rotation correlated with HI.
Conclusions:
- The sandwiched bar and screw fixation system is a safe and effective minimally invasive treatment for pectus carinatum.
- Sternal rotation and asymmetry index are key factors influencing postoperative results.
- This technique offers a promising solution for PC deformities, with excellent patient outcomes.
Background And Aims:
Pectus carinatum (PC) is the second most common deformity of the anterior chest wall, resulting in detrimental effects on body image and quality of life. This study evaluated the safety, effectiveness, and factors associated with the treatment of PC using a sandwiched bar and screw fixation system, first performed in Vietnam at the University Medical Center Ho Chi Minh City in 2016.
Methods:
This retrospective cohort study was conducted from March 2016 to February 2023 in patients with PC and PC-mixed pectus excavatum (PE) deformities. All patients underwent corrective surgery using the sandwiched bar and screw fixation system. Data were collected on demographic characteristics, operative time, length of hospital stay, Haller Index (HI), and postoperative complications. The effectiveness of the procedure was evaluated based on changes in the HI. Statistical analyses were performed using paired t-tests to compare preoperative and postoperative HI values, and multivariate linear regression was used to identify factors associated with postoperative outcomes.
Results:
Of the 39 consecutive patients, 12 (30.8%) had symmetric PC, 10 (25.6%) asymmetric PC, and 17 (43.6%) had PC with an excavatum complex. The mean operative time was 68.1 ± 35.8 min, and the length of stay was 5.3 ± 1.1 days. The preoperative and postoperative Haller index (HI) values were 1.96 ± 0.13 and 2.49 ± 0.14, respectively (p < 0.001). Independent variables correlated to postoperative HI included the asymmetry index absolute value (coefficient (β) = 0.649, p < 0.001) and angle of sternal rotation (β = -0.008, p < 0.001). The percentage of patients with good outcomes was 97.4%. No serious procedure-related complications were observed.
Conclusion:
Minimally invasive repair using the sandwiched bar and screw fixation system is an effective and safe treatment for PC. Sternal rotation and asymmetry index contribute to its effectiveness by correlating to postoperative HI.
