Delayed intrathoracic pectus bar displacement after minimally invasive repair of pectus excavatum using the short bar technique: a case series.

Introduction: Bar displacement is among the most frequently reported complications after minimally invasive repair of pectus excavatum. To mitigate this risk, various modifications to the original Nuss procedure have been introduced, including alternative bar configurations and stabilization systems. We describe three patients with delayed intrathoracic bar displacement following the short bar technique, highlighting the particular circumstances, corrective measures, and potential preventive strategies. Presentation of cases: Three male patients, aged 15-20 years, who had undergone minimally invasive repair of pectus excavatum using a short, 10-inch bar, presented with intrathoracic implant displacement. Two patients reported chest pain 10 and 13 months postoperatively, whereas the third remained asymptomatic and was diagnosed incidentally. All patients underwent safe reoperation, with thoracoscopic bar replacement in one case and bar removal in two cases. Presumed causes of displacement included mechanical failure and intercostal muscle stripping. Discussion: Intrathoracic bar migration may compromise cardiopulmonary structures and pose challenges for surgical bar removal. While shorter bar configurations, designed to enhance stability, have shown promising results, our case series underscores that intrathoracic displacement is a risk associated with this modified approach. Strategies such as asymmetrical bar placement and hinge point reinforcement may help prevent this complication. Conclusion: Although effective, the short bar technique requires optimal bar positioning and stabilization to mitigate pectus bar displacement and related adverse events.