Outcomes following the modified Ravitch repair for pectus carinatum are fairly positive with high postoperative patient satisfaction rates [25] and minimal complications. Complications reported include seroma, wound infection, pleural effusions, pneumothorax, and local tissue necrosis [1, 26]. Recurrence rates are reported to be 1.8–5.5 % [23, 24, 27]. Most authors advocate for delaying repair until after puberty in order to reduce the rate of recurrence [28].

The first minimally invasive technique for pectus carinatum repair was described in 1997 by Kobayashi et al. using a subcutaneous endoscopic technique with multiple stab incisions to facilitate the cartilage resection [29]. Other techniques described in the literature include using subpectoral insufflation or thoracoscopic-assisted methods to assist with rib resection [30, 31]. These techniques involve novel minimally invasive methods of creating operative space to perform the rib resection; however, widespread use is yet to be adopted.

In 2009, Abramson et al. described a novel technique not requiring cartilage resection to treat pectus carinatum in which a curved steel bar is inserted subcutaneously and fixed to the lateral ribs using fixation plates and subperiosteal wires. The bar applies manual pressure to the anterior chest wall until the desired anatomical configuration is achieved. In their initial series of 40 patients, “highly satisfactory results” were reported with 10/20 patients followed. Complications with this technique reported included pneumothorax requiring chest tube, skin adherence to the bar, seroma formation, wire malfunction, persistent pain, and wound infection. Based on the initial data, the study concluded that the best results could be seen in younger patients whose chest wall was more flexible [32]. It is also important to note that this bar-based technique is not useful in treating chondromanubrial defects where point of maximum protrusion is too superiorly located and there is more limited chest wall compliance.