title: Complications of the minimally invasive repair of pectus excavatum.
abstract: BACKGROUND
  Minimally invasive repair of pectus excavatum (MIRPE) has become widely popular since its introduction in the late 1990s by Nuss. We describe 1 unusual complication after MIRPE and 1 life-threatening bleeding during removal of the pectus bar.
  
  
  METHODS
  We report the cases of 2 patients in a single institution, more than 100 MIRPE procedures performed so far, and review of literature.
  
  
  METHODS
  A 14-year-old girl presented 6 months after MIRPE in another institution. During removal of the pectus bar, a massive hemorrhage from both chest wounds occurred, requiring emergency sternotomy. Arrosion of a pulmonary vessel close to the metal bar had led to the bleeding. The second case was a bilateral sternoclavicular dislocation after MIRPE, which has not caused symptoms so far, in a 13-year-old girl.
  
  
  CONCLUSIONS
  Numerous operative and postoperative complications after MIRPE are feasible. This is the first report of a life-threatening bleeding during removal of the pectus bar. Minimally invasive repair of pectus excavatum procedure and removal of the pectus bar should only occur in specialized institutions with wide experience in thoracic surgery.
authors.affiliation: Department of Pediatric Surgery, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Leonhardt
authors.forename: Joachim F
authors.initials: JF
authors.lastname: Kübler
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Feiter
authors.forename: Benno M
authors.initials: BM
authors.lastname: Ure
authors.forename: Claus
authors.initials: C
authors.lastname: Petersen
mesh_terms: D000293:Adolescent; D002968:Clavicle / Q000293:injuries; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D019736:Prostheses and Implants / Q000009:adverse effects*; D013249:Sternum / Q000293:injuries / Q000601:surgery