Comparison of the Outcomes of Double-Bar and Non-Double-Bar Techniques in the Minimally Invasive Repair of Pectus Excavatum: A Focus on Bar Removal and Complications

Abstract

Background/Objectives: Minimally invasive repair of pectus excavatum (MIRPE) techniques are classified into non-double-bar methods, which elevate the chest wall only, and double-bar methods, which involve both elevation and compression. Our objective was to compare the clinical outcomes of MIRPE procedures between the double-bar and non-double-bar techniques, with a particular focus on bar removal operation time and its associated complications. Methods: This retrospective study included 103 patients who were diagnosed with pectus excavatum and underwent MIRPE between January 2015 and July 2022. Propensity score matching was performed to adjust for confounding variables between patients who underwent the double-bar procedure and those who underwent the non-double-bar procedure. Comparative analyses between the groups were conducted using t-tests and chi-square tests, and linear regression was used to identify the risk factors for a prolonged bar removal time. Results: After propensity score matching, 48 patients were matched, with each group consisting of 24 patients. The double-bar group had a shorter hospital stay after bar insertion (p < 0.001), a reduced bar removal operation time (p < 0.001), and a lower incidence of chest X-ray bony spurs (p = 0.018) compared to the non-double-bar group. Multivariate linear regression model showed non-double-bar use and the presence of a chest X-ray bony spur were significant risk factors for a prolonged bar removal operation time. Conclusions: The double-bar technique demonstrated significant advantages, such as reduced bar removal operation times and fewer complications, making it the preferable surgical approach. Nevertheless, further prospective studies with larger sample sizes are needed to validate these findings.