A case report of sandwiched double-bar correction for pectus excavatum: surgical technique and technical considerations

Introduction Selected pectus excavatum patients may require more than a single retrosternal bar to achieve balanced remodeling and stable fixation. We describe a sandwiched double-bar correction technique for pectus excavatum. Case Presentation An 11-year-old girl presented with an anterior chest wall deformity noticed since early childhood, with exertional fatigue and difficulty participating in exercise and peer games. Examination showed asymmetric flat-type pectus excavatum, Park type 2A2. Computed tomography confirmed the deformity, with a Haller index of 3.2. Under general endotracheal anesthesia, the patient was placed supine with both arms abducted. The deepest depression point and bar entry sites were marked. A size 30 internal bar was shaped for retrosternal elevation and a size 29 external bar for presternal support. Sternal suspension sutures were placed before tunneling. Through bilateral small lateral chest incisions, a presternal subcutaneous tunnel and a retrosternal tunnel were created. The internal bar was passed behind the sternum, and the external bar was passed anterior to the sternum. The bars were compressed toward each other and fixed bilaterally with screws. Immediate inspection showed satisfactory correction and improved symmetry. No perioperative complications occurred. She was discharged on postoperative day 3. At 1 month, she had no pain, required no analgesics, had resumed daily activities, and returned to school 2 weeks after surgery. Conclusion Sandwiched double-bar correction may be a feasible technical option for selected pectus excavatum patients requiring additional anterior counter-support and stable fixation.