Pectus Carinatum Repair Using the Sandwiched Bars and Screw Fixation System: A Retrospective Cohort Study of a Single Center Experience

Abstract

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.