Bar Dislocation after Pectus Excavatum Repair: A Systematic Review of Risk Factors, Stabilization Techniques, and Management Strategies.

Background: Pectus excavatum (PE), the most common congenital chest wall deformity, is increasingly treated with minimally invasive repair (MIRPE). However, postoperative complications such as bar displacement remain a significant challenge, occurring in approximately 9.5% of cases. While surgical modifications and stabilization techniques aim to reduce risks, bar displacement persists as a critical concern. Methods: This PROSPERO-registered systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search of PubMed, Scopus, and CINAHL through October 2024 identified studies evaluating bar displacement in PE patients undergoing MIRPE or alternative surgical approaches. The inclusion criteria focused on risk factors, stabilization techniques, and reoperation strategies. Data extraction and risk-of-bias assessments were independently conducted by multiple reviewers to ensure accuracy and quality. Results: Thirteen studies spanning 23 years were included. Bar displacement rates varied widely (0.9%-33.3%), with key risk factors including patient age, chest wall rigidity, bar length, and placement technique. Advanced stabilization methods-such as bridge fixation, shorter bars, multipoint fixation, and adjunct stabilizers-significantly reduced displacement rates. Common postoperative complications included wound infections, seromas, pleural effusions, and bar re-dislocation. Imaging modalities like chest X-rays and 3-dimensional computed tomography scans proved critical for early detection. Heterogeneity in stabilization approaches underscores a shift toward patient-specific strategies to optimize outcomes. Conclusion: Tailored stabilization techniques are essential for successful PE correction. Although advancements in fixation methods have reduced displacement risks, standardized postoperative protocols and multicenter studies are needed to validate these innovations and improve long-term outcomes (PROSPERO: CRD42024595337).