Research on Surgical Strategies for the Correction of Pectus Excavatum in Children via an Extrapleural Approach

Abstract

Objective: To investigate the clinical efficacy and safety of the extrapleural approach versus the traditional intrathoracic approach in minimally invasive correction of pectus excavatum in children, providing a more scientific basis for selecting a more appropriate surgical method in clinical practice. Methods: This study included 50 children who underwent pectus excavatum correction at Harbin Children’s Hospital from January 2023 to January 2025. All patients were divided into two groups based on surgical approach: the observation group (n = 26) and the control group (n = 24). Children in the observation group underwent correction surgery via an extrapleural approach, while those in the control group underwent correction surgery via the traditional intrathoracic approach. Both groups underwent Nuss bar placement surgery under thoracoscopic guidance. Intraoperative indicators were compared between the two groups, including operative time, blood loss, pain scores at 24 and 48 hours postoperatively, hospital stay duration, thoracic correction outcomes, and the incidence of complications during a 6-month postoperative follow-up. Results: The intraoperative blood loss in the observation group was significantly lower than that in the control group (p < 0.05), and the pain scores at 24 and 28 hours postoperatively were also significantly lower (p < 0.05). The improvement in thoracic index postoperatively was relatively similar between the two groups, with no statistically significant difference (p > 0.05). During the 6-month postoperative follow-up period, no complications such as pneumothorax, hemothorax, pleural effusion, plate displacement, or infection occurred in the observation group, whereas the overall complication rate in the control group was 25%, showing a significant difference (p < 0.05). Conclusion: The extrapleural approach for corrective surgery can ensure the efficacy of thoracic deformity correction while reducing intraoperative blood loss, lowering the incidence of complications, alleviating postoperative pain, and accelerating recovery. It is a safe and effective approach for minimally invasive Nuss correction of pediatric pectus excavatum.