Pectus Up Intervention for Pectus Excavatum Using the Double Bar Technique

Pectus excavatum is the most common congenital chest wall deformity, and severe cases may require operative correction to improve both physiological and cosmetic outcomes. The authors present the case of a 16-year-old male with severe symmetric pectus excavatum and a Haller index of 5.4 who underwent correction using a modified double-bar Pectus Up technique.

Preoperative computed tomography-based mapping was used to determine the exact position of the incisions, plates, and screw lengths. Bilateral vertical incisions were created, followed by extensive subpectoral dissection to create pockets for the external bars. Due to the severity of the deformity, two Pectus Up bars were selected to optimize the distribution of corrective forces across the anterior chest wall.

Base plates were positioned precisely on the sternum according to the preoperative plan and secured using unicortical screws engaged only the anterior sternal table. Multiple bilateral anterior chondrotomies of the second through fifth costal cartilages were then performed to facilitate the elevation and remodeling of the sternum while preserving cartilage continuity.

Following the placement of the lifting device, progressive elevation of the sternum was achieved and secured to the external bars, resulting in immediate correction of the deformity and restoration of a physiologic anterior chest contour. Optional reinforcing wires were added for additional support.

The procedure avoided intrathoracic dissection, lung deflation, and cryoanalgesia. The patient experienced minimal postoperative pain, rapid mobilization, and was discharged on postoperative day one with an excellent cosmetic result and high patient satisfaction. This video highlights the feasibility and advantages of a double-bar Pectus Up approach in selected patients with severe pectus excavatum.

References

1. Frediani S, Beati F, Pardi V, et al. Modified Taulinoplasty: a new minimally invasive technique for the treatment of pectus excavatum. Front Surg. 2024.
2. Frediani S, Corbi L, Pardi V, et al. Double Pectus Up in severe pectus excavatum: the new frontier of modified Taulinoplasty. Front Pediatr. 2024.

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.