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

This systematic review evaluated bar displacement following pectus excavatum repair focusing on studies assessing risk factors, stabilization methods, and reoperation strategies. Thirteen studies spanning 23 years were included, revealing bar displacement rates ranging from 0.9 percent to 33.3 percent.  Key patient-related risk factors included age and chest wall rigidity. Advanced surgical techniques—particularly bridge fixation, multipoint fixation, and adjunct stabilizers—demonstrated significant reductions in displacement rates. Specific studies highlighted the ZipFix system as a notably superior stabilization method.  The analysis underscores the necessity of personalized approaches in minimally invasive pectus excavatum repair (MIRPE) to address bar displacement. However, the lack of standardized protocols has resulted in insufficient data and consensus on optimal practices, such as the number of bars required or the most effective fixation methods to counteract Nuss bar rotational torque.