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OBJECTIVE: Bar flipping displacement is one of the most common complications after Nuss operation for pectus excavatum. We evaluated the results of modified Nuss operstion with needlescope assisted bar fixation technique.
METHODS: Records of 41 patients with pectus excavatum who underwent single pectus bar insertion with/without needlescope-assisted 3-point fixation from July 2011 to August 2014 were retrospectively analyzed. The patients were divided into two groups (group A: without 3-point fixation; group B: with 3-point fixation). We measured the position of the pectus bar with the angle degree on the lateral view of chest radiograph. The slope angle of the bar was measured based on the inferior boundary of the superior mediastinum (Figure 1), the anatomic landmark passing from the sternal angle to the junction of the 4th and 5th thoracic vertebrae (line AB). The parallel line to the inferior border of the superior mediastinum (line ab) was drawn. The angle formed by a line passing through two points on the superior or inferior margin (arrowheads) of the side hole of the bar (line cd) and this line (line ab) represented the angle position of the bar.
RESULTS: A mean age of 41 patients (male 36, female 5) was 10.7 ± 8.3 years (range: 3 to 36 years). There was no significant difference in age, weight, height, BMI, and pre- and post-operative HI between the two groups. The angle of the postoperatively initial position of the bar was 8.20 ± 10.16o and showed no difference between the two groups (p > 0.05). Two patients underwent reoperation to correct the bar displacement, which showed the angle difference of 47.5o and 36.5o. The rate of corrective surgery was decreased in group B (group A 1/11, 9.1%; group B 1/30, 3.3%).
CONCLUSIONS: Needlescope-assisted 3-point fixation of the bar was performed without additional skin incision and showed decreased rate of reoperation to correct the pectus bar displacement.