Eight Years of Expertise With the Sandwich Technique for Asymmetric Pectus Carinatum and Excavatum-Carinatum Complex

The Sandwich technique is a novel approach for managing pectus carinatum and the excavatum-carinatum complex. Although first described in 2016, literature and global experience are scarce. We report our eight-year experience using the Sandwich technique, with a special focus on surgical aspects.

Multicentric, retrospective study (2017-2024) including patients undergoing the Sandwich technique for pectus carinatum and excavatum-carinatum complex with a similar approach was conducted in three centers. Under thoracoscopic guidance and using sternal elevation, internal bars were introduced in a parallel or crossed disposition and fixated with lateral bridges to elevate excavated areas. Next, the external submuscular bar was placed to flatten protruding areas and fixated to the bridges directly or using polyethylene tape.

Twenty-four patients (16 being male) with a mean age of 16.6 ± 2.7 years were included. Nineteen patients had excavatum-carinatum complex, while 6 had pectus carinatum. The average operative time was 156 ± 59.3 min. Internal bars were placed in a parallel disposition in 21 cases and crossed in 3. Additional procedures such as flare-buster, magic string, or thoracoscopic chondral resection were performed in 10. There were 3 complications: intercostal stripping, unilateral pneumothorax secondary to undiagnosed ruptured bullae, and superinfected granuloma. The median patient satisfaction score was 4.5 on a 5-point Likert Scale.

Despite technical variations, the sandwich technique offers satisfactory outcomes for a selected subgroup of pectus carinatum and excavatum-carinatum complex patients. The indication, number of bars, and their disposition require diligent planning.

retrospective study.

IV.