Comparison of surgical approaches for pectus excavatum in children and adolescents: a single-center retrospective study

Objective This study aimed to compare the clinical utility of two modified Nuss procedures in children and adolescents with pectus excavatum (PE), including single-incision modified Nuss and modified Nuss with non-flipping bar. It sought to delineate patient selection patterns, assess perioperative parameters, postoperative recovery, complication rates, and short/intermediate-term efficacy of the two approaches, thereby providing evidence-based guidance for individualized surgical selection. Methods A single-center retrospective cohort study was conducted on pediatric and adolescent PE patients who underwent surgical correction at Shanghai Children's Hospital between January 2015 and December 2022. Patients were categorized by the intended operative strategy: single-incision modified Nuss (single working incision with optional thoracoscopy through the same incision) versus modified Nuss with a pre-shaped non-flipping bar (advanced without intraoperative 180° turnover). A total of 171 patients were included (140 single-incision; 31 non-flipping bar). Demographic data, clinical characteristics, surgical parameters, and postoperative outcomes were collected. Results Regarding surgical parameters, the non-flipping bar group had longer median operative time, more incisions, and lower screw fixation rate. Postoperatively, the non-flipping bar group showed a higher median Haller index, but this difference had limited clinical significance. No significant differences were noted in overall complication rates, postoperative recovery indicators, or surgical efficacy. After PSM, no statistical difference in therapeutic efficacy was found between the two groups. Conclusion Both the single-incision modified Nuss procedure and the modified Nuss procedure with non-flipping bar are effective and safe for PE in children and adolescents, with comparable therapeutic efficacy. Surgical selection should be tailored to patient age and deformity characteristics.