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Table 3 Review of major articles reporting the bar removal after Nuss procedure

From: Minimization of the complications associated with bar removal after the Nuss procedure in adults

Study (year)Number of patients (number of bar)Age (years), mean ± SD (range)Interval (years) mean ± SD (range)Operation techniqueComplications
Bilgi et al. (2017) [11]246 (1 bar: 162;
2 bars: 80;
3 bars: 4)
17.7 ± 6.2 (age of repair)2.88 ± 1.43Position: supine
Incision: bilateral
Straightening: bilateral
Others: Subcutaneous drain for preventing seroma by surgeon’s discretion.
Seroma: 29 (11.7%); pneumothorax: 3 (1.2%); pleural effusion: 2 (0.8%); secondary intervention: 6 (2.4%; 3 massive bleeding). Risk factor: double bars removal
Park et al. (2016) [22]1821 (NM*)9.13 (1.3–44, age of repair)2.57 (0.3–14). 2.02 for < 12 years; 2.99 for 12–20 years; 3.53 for > 20 yearsPosition: supine
Incision: bilateral
Straightening: bilateral
Others: osteotome, rongeur dissection or electric drilling for removal callus. Sternal wire for malpositioned pectus bars, or crane elevation of the sternum.
Seroma/infection: 43 (2.36%); pleural effusion: 3 (0.16%); bleeding: 3 (0.16%; 1 cardiopulmonary bypass for hemostasis); hemothorax: 1 (0.05%)
Liu et al. (2013) [18]186
1 bar: 184
2 bars: 2
9.8 (5–26) (age of removal)2 years: 133
≥2.5 years: 53
Position: supine
Incision: right side
Straightening: no
Others: the tip of the bar grafted with a bar flipper, and the flipper was turned several times in the clockwise and counterclockwise direction to loosen the bar from the surrounding fibrous capsule
Pneumothorax: 3 (1.6%)
Nyboe et al. (2011) [21]334
1 bar: 281
2 bars: 53
19.1 (age of bar removal)3.12 (1.76–7.05).Position: supine
Incision: unilateral (n = 218); bilateral (n = 116)
Straightening: not routine
Other: postoperative X-ray not as a routine
Pneumothorax: 5 (1.4%;); hemothorax: 3 (1.0%; 1 requiring open surgery, 2 treated with a chest tube)
Fike et al. (2012)230 (NM)16.7 (7.8–25.3) (age of bar removal)2.8 (0.9–9.2Position: supine; two tables with T-shape
Incision: bilateral
Straightening: no
Wound infection: 6 (3%); Massive bleeding: 1 (0.4%; with blood transfusion)
Chon et al. (2011) [20]21 (NM)NMNMPosition: prone
Incision: unilateral
Straightening: no
No complication
Varela et al. (2010) [24]21 (NM)NMNMPosition: lLateral (20); supine (1)
Incision: Unilateral (20); bilateral (1)
Straightening: No (20); yes (1; unilateral)
No complication
de Campos et al. (2009) [17]14 (NM)NMNMPosition: supine
Incision: bilateral
Straightening: bilateral
Others: using a protective film around one end of bar
Intraoperative bleeding: 1 (surgical exploration)
St Peter et al. (2007) [19]110 (NM)NMNMPosition: supine; two tables with T-shape
Incision: bilateral
Straightening: no
No complication
Fujita et al. (2005) [25]10 (1 bar: 10)NMNMPosition: supine
Incision: bilateral
Straightening: bilateral
No complication
  1. NM not mentioned