Table 3.
Review of major articles reporting the bar removal after Nuss procedure
| Study (year) | Number of patients (number of bar) | Age (years), mean ± SD (range) | Interval (years) mean ± SD (range) | Operation technique | Complications |
|---|---|---|---|---|---|
| Bilgi et al. (2017) [11] |
246 (1 bar: 162; 2 bars: 80; 3 bars: 4) |
17.7 ± 6.2 (age of repair) | 2.88 ± 1.43 |
Position: supine Incision: bilateral Straightening: bilateral Others: Subcutaneous drain for preventing seroma by surgeon’s discretion. |
Seroma: 29 (11.7%); pneumothorax: 3 (1.2%); pleural effusion: 2 (0.8%); secondary intervention: 6 (2.4%; 3 massive bleeding). Risk factor: double bars removal |
| Park et al. (2016) [22] | 1821 (NM*) | 9.13 (1.3–44, age of repair) | 2.57 (0.3–14). 2.02 for < 12 years; 2.99 for 12–20 years; 3.53 for > 20 years |
Position: supine Incision: bilateral Straightening: bilateral Others: osteotome, rongeur dissection or electric drilling for removal callus. Sternal wire for malpositioned pectus bars, or crane elevation of the sternum. |
Seroma/infection: 43 (2.36%); pleural effusion: 3 (0.16%); bleeding: 3 (0.16%; 1 cardiopulmonary bypass for hemostasis); hemothorax: 1 (0.05%) |
| Liu et al. (2013) [18] |
186 1 bar: 184 2 bars: 2 |
9.8 (5–26) (age of removal) |
2 years: 133 ≥2.5 years: 53 |
Position: supine Incision: right side Straightening: no Others: the tip of the bar grafted with a bar flipper, and the flipper was turned several times in the clockwise and counterclockwise direction to loosen the bar from the surrounding fibrous capsule |
Pneumothorax: 3 (1.6%) |
| Nyboe et al. (2011) [21] |
334 1 bar: 281 2 bars: 53 |
19.1 (age of bar removal) | 3.12 (1.76–7.05). |
Position: supine Incision: unilateral (n = 218); bilateral (n = 116) Straightening: not routine Other: postoperative X-ray not as a routine |
Pneumothorax: 5 (1.4%;); hemothorax: 3 (1.0%; 1 requiring open surgery, 2 treated with a chest tube) |
| Fike et al. (2012) | 230 (NM) | 16.7 (7.8–25.3) (age of bar removal) | 2.8 (0.9–9.2 |
Position: supine; two tables with T-shape Incision: bilateral Straightening: no |
Wound infection: 6 (3%); Massive bleeding: 1 (0.4%; with blood transfusion) |
| Chon et al. (2011) [20] | 21 (NM) | NM | NM |
Position: prone Incision: unilateral Straightening: no |
No complication |
| Varela et al. (2010) [24] | 21 (NM) | NM | NM |
Position: lLateral (20); supine (1) Incision: Unilateral (20); bilateral (1) Straightening: No (20); yes (1; unilateral) |
No complication |
| de Campos et al. (2009) [17] | 14 (NM) | NM | NM |
Position: supine Incision: bilateral Straightening: bilateral Others: using a protective film around one end of bar |
Intraoperative bleeding: 1 (surgical exploration) |
| St Peter et al. (2007) [19] | 110 (NM) | NM | NM |
Position: supine; two tables with T-shape Incision: bilateral Straightening: no |
No complication |
| Fujita et al. (2005) [25] | 10 (1 bar: 10) | NM | NM |
Position: supine Incision: bilateral Straightening: bilateral |
No complication |
NM not mentioned