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The Cross-bar Technique for Pectus Excavatum Repair: A Key Element for Remodeling of the Entire Chest Wall.

INTRODUCTION
The multiple bar approach was developed to cover broader and heavier teenager/adult chest wall deformities. We designed the cross-bar technique to achieve remodeling of the entire chest wall. This study aimed to demonstrate the role of cross-bar and its benefits over the parallel-bar.


MATERIALS AND METHODS
The cross-bar technique involves placing two bars diagonally and then cross on the target. The primary purposes are to double the lifting forces by making two bars converge on a single target to lift inflexible heavy chest wall depressions or cover lower lateral areas. The results of the cross-bar and parallel-bar are compared for the indications, post-repair outcomes, and complications.


RESULTS
From 2016 to 2019, 247 patients who underwent multiple bar pectus excavatum repair were enrolled in the study: 157 with cross-bar and 90 with parallel-bar. In cross-bar group, 33% (51/157) received three bars in XI fashion to cover the upper depression. Cross-bar group were older (18.0±6.1 vs. 15.7±5.0), had higher Depression index (1.9±0.7 vs. 1.8±0.3), and were less asymmetric (45% vs. 71%) than those in parallel-bar group. The overall complication rates were not different between two groups (9.6% vs. 10%, p=1.0), although cross-bar group was more rigid and complex. There was no bar displacement or reoperation in both groups.


CONCLUSIONS
The cross-bar technique is as safe and effective as the parallel-bar technique, even though it was selected to correct more complexities. The cross-bar technique could be a method for complex PE deformities for remodeling of the entire chest wall.