title: A simple technique for pectus bar removal using a modified Nuss procedure.
abstract: BACKGROUND
  Although the Nuss procedure has been widely accepted as the standard procedure for the repair of pectus excavatum in children, adolescents, and even adults, few reports have documented the bar removal procedure as a whole. In this study, we retrospectively evaluated the safety and efficacy of a modified Nuss bar removal procedure.
  
  
  METHODS
  A total of 186 patients undergoing bar removal after the Nuss procedure were included in this study. All cases had unilateral incision (metallic stabilizers were used on one side in all patients). Patients were laid down in the supine position and given general anesthesia through a single lumen tracheal tube or laryngeal mask. The bar was pulled out along the thoracic wall without straightening or overturning through the original right incision.
  
  
  RESULTS
  The mean operation time for bar removal was 12 min (range: 8-20 min). The mean operative blood loss was 5 mL (range: 3-20 mL). No patient suffered from an infection at the incision after surgery, but 3 patients (1.6%) developed mild pneumothorax. All patients were discharged from the hospital within a day after the surgery. The bar in 133 patients (71.5%) was removed in 2 years after Nuss procedure but more than two and a half years in 53 patients (28.5%). The patients were followed up for 4 to 48 months with a mean of 21.4 months. No recurrence was observed during the follow-up period.
  
  
  CONCLUSIONS
  The Nuss bar can be safely and easily removed in 2 years or longer after the Nuss procedure. Our study suggests that, after removing the metallic stabilizer, the bar should be turned with the flipper to loosen it from the surrounding fibrous capsule and then pulled out along the original surgical incision without bending or turning.
authors.affiliation: Department of Thoracic Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China. liuwenliang1859@gmail.com
authors.forename: Wenliang
authors.initials: W
authors.lastname: Liu
authors.forename: Demiao
authors.initials: D
authors.lastname: Kong
authors.forename: Fenglei
authors.initials: F
authors.lastname: Yu
authors.forename: Bangliang
authors.initials: B
authors.lastname: Yin
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000517:prevention & control; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009984:Orthopedic Fixation Devices; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012399:Rotation; D013249:Sternum / Q000601:surgery; D055815:Young Adult