Choosing between the modified Ravitch and Nuss procedures for pectus excavatum: Considering the patients’s perspective

Abstract

INTRODUCTION Pectus excavatum (PE) is the most common paediatric chest wall deformity. The majority of patients are treated for cosmetic purposes, with the modified Ravitch and Nuss procedures the most commonly performed. We tested the preferences of healthy individuals over their choice of procedure. METHODS The study was conducted from February to August 2014. A five-item illustrated questionnaire was administered to teenagers and young adults aged 14-26 years over their willingness to seek medical advice if they had PE, provided its cosmetic appearance was the only complaint. They were asked about their preference over the modified Ravitch and Nuss procedures, with the surgical details for both procedures explained by medical professionals, alongside illustrated outcomes. RESULTS Two hundred and two healthy individuals were interviewed. The median age was 19.5 years (14-26 years) and 141 (69.8%) were male. Sixty seven (33.2%) participants refused any intervention, while 11 (5.4%) initially wanted an intervention but refused after understanding the surgical procedures available. Of the 135 respondents who chose surgical correction, 84 (62.2%) preferred the modified Ravitch operation, while 51 (37.8%) preferred the Nuss procedure. The main reason for choosing the modified Ravitch technique was not having something metal in the chest, while most participants who chose the Nuss procedure felt that it was "cosmetically better". CONCLUSIONS Patients have preferences over the choice of procedure for PE repair that can affect the treatment decision. Paediatric and thoracic surgeons should therefore be experienced in performing both procedures.

Evolution of technique and results after permanent open repair for pectus deformities

“…The EBL within our study had a median of 110 mL, which falls within the wide range of other reports of 33 mL to 359 mL with similar repairs. 10 , 11 The median LOS among our cohort was 4 days, which is comparable with other reports. 11 The shorter operative times in our study while maintaining acceptable EBL and LOS suggest that our method remains an efficient procedure.…”

“…Multiple studies have compared open and minimally invasive techniques to understand the relative success associated with each method. 3 , 6 , 10 , 11 Perioperative data show similar findings in operative times, estimated blood loss (EBL), and postoperative length of stay (LOS). 6 , 10 Although the minimally invasive approach of the Nuss procedure offers several advantages, the Ravitch type repair has been shown to have a higher degree of long-term satisfaction.…”

“… 6 Furthermore, patients were more likely to choose the Ravitch procedure over the Nuss because of an aversion to having a metal bar left inside the chest. 11 On the basis of these principles, a single-stage operation using a plate instead of a bar with long-term durability would be able to achieve good results with a high level of satisfaction.…”

Pectus Updates and Special Considerations in Marfan Syndrome

“… 24 Patient preference should be considered however, as recent studies have also suggested that many patients have strong preferences regarding whether they would prefer a minimally invasive procedure or whether they would prefer not to have metalwork in their body. 32 …”

An automatic bender for customized pectus bar

“…The Nuss procedure is a minimally invasive alternative to the Ravitch procedure for the treatment of pectus deformities. It involves only internal bracing without resection of the abnormal cartilage [8]. It aims to force the sternum forward and hold it there with an implanted steel bar, but without performing a long incision to resect the abnormal cartilage [5].…”