title: Minimally Invasive Repair of Pectus Excavatum Without Bar Stabilizers Using Endo Close.
abstract: OBJECTIVE
  Since the introduction of the Nuss technique for pectus excavatum (PE) repair, stabilization of the bar has been a matter of debate and a crucial point for the outcome, as bar dislocation remains one of the most frequent complications. Several techniques have been described, most of them including the use of a metal stabilizer, which, however, can increase morbidity and be difficult to remove. Our study compares bar stabilization techniques in two groups of patients, respectively, with and without the metal stabilizer.
  
  
  METHODS
  A retrospective study on patients affected by PE and treated by the Nuss technique from January 2012 to June 2013 at our institution was performed in order to evaluate the efficacy of metal stabilizers. Group 1 included patients who did not have the metal stabilizer inserted; stabilization was achieved with multiple (at least four) bilateral pericostal Endo Close™ (Auto Suture, US Surgical; Tyco Healthcare Group, Norwalk, CT) sutures. Group 2 included patients who had a metal stabilizer placed because pericostal sutures could not be used bilaterally. We compared the two groups in terms of bar dislocation rate, surgical operative time, and other complications. Statistical analysis was performed with the Mann-Whitney U test and Fisher's exact test.
  
  
  RESULTS
  Fifty-seven patients were included in the study: 37 in Group 1 and 20 in Group 2. Two patients from Group 2 had a bar dislocation. Statistical analysis showed no difference between the two groups in dislocation rate or other complications.
  
  
  CONCLUSIONS
  In our experience, the placement of a metal stabilizer did not reduce the rate of bar dislocation. Bar stabilization by the pericostal Endo Close suture technique appears to have no increase in morbidity or migration compared with the metal lateral stabilizer technique.
authors: 1 Pediatric Surgery Department, Istituto Giannina Gaslini , Genoa, Italy .|2 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa , Genoa, Italy .
authors: Luca
authors: L
authors: Pio
authors: 1 Pediatric Surgery Department, Istituto Giannina Gaslini , Genoa, Italy .|2 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa , Genoa, Italy .
authors: Marcello
authors: M
authors: Carlucci
authors: 1 Pediatric Surgery Department, Istituto Giannina Gaslini , Genoa, Italy .|2 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa , Genoa, Italy .
authors: Lorenzo
authors: L
authors: Leonelli
authors: 3 Epidemiology and Biostatistics Section, Scientific Directorate, Istituto Giannina Gaslini , Genoa, Italy .
authors: Giovanni
authors: G
authors: Erminio
authors: 1 Pediatric Surgery Department, Istituto Giannina Gaslini , Genoa, Italy .|2 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa , Genoa, Italy .
authors: Girolamo
authors: G
authors: Mattioli
authors: 1 Pediatric Surgery Department, Istituto Giannina Gaslini , Genoa, Italy .
authors: Michele
authors: M
authors: Torre
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008670:Metals; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013537:Sutures; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D008670:Metals