To Cross or Not to Cross: The Cross-Bar Technique to Correct Pectus Excavatum With "Costal Flaring".

Background: The minimally invasive repair of pectus excavatum (PE), introduced by Nuss in 1998, represents the worldwide "gold standard" procedure for surgical repair. Modifications over years included routine use of unilateral or bilateral thoracoscopy as well as sternal elevation before starting the substernal dissection. In patients with a severe PE deformity, such as Grand Canyon type, use of a second bar or, in selected patients, even a third or fourth bar has to be considered. However, not only the number of bars but also positioning may vary. Park established the so-called cross-bar technique to correct a wider range of PE deformities, especially at the lower part of the depression. Methods: We report our experience applying the cross-bar technique in 5 PE patients presenting with severe bilateral costal flaring. Results: With unilateral thoracoscopy and sternal elevation using the vacuum bell, surgical repair went well in all patients. Fortunately, we noticed no secondary bar displacement or any other serious postoperative complication; 1 of the 5 patients completed treatment with elective pectus bar removal. Optimal correction of the deformity was achieved in all patients; the outcome was excellent. Conclusions: Individualized surgical repair is mandatory in PE patients presenting with complex deformities. In PE patients presenting with concomitant bilateral costal flaring or depression of the lower part of the chest wall, we recommend the cross-bar insertion technique for surgical repair to achieve excellent cosmetic results.