Meta-Analysis of Ravitch and Nuss Procedures for the Treatment of Funnel-Shaped Chest Deformity in Children and Adolescents

Abstract

Funnel-shaped chest deformity is the most common anomaly of the chest wall development, occurring in 8 out of every 1 000 children. The defect is noticeable at birth in approximately 86 % of patients with chest deformity. Objective. To conduct a systematic review comparing the treatment of funnel-shaped chest deformity in children and young people under 20 years of age by surgical methods according to Ravitch and Nuss by the number of complications that occur in the short (up to 30 days) and long-term periods (2–3 years). Methods. A search of scientometric databases revealed 1 734 sources, of which 8 papers were selected for further analysis. Results. We evaluated systematic reviews and meta-analyses comparing methods of treatment of lumbar deformity in children and adolescents. It was determined that there are currently no randomized trials comparing these procedures in children and adolescents. A comparative analysis of the risk of complications in the surgical treatment of the funnel-shaped sternum in children and young adults using the Ravitch and Nuss methods determined that there is no difference in the overall incidence of complications between the Nuss and Ravitch procedures when considering the pediatric population in terms of overall, early, and late complications. With the development of the Nuss technology, complications associated with plate mixing are practically non-existent, and the development of new methods of controlling operations, anesthesia and further patient management has reduced the development of both postoperative and long-term complications. Conclusions. According to the results of the meta-analysis of the risk of early and late complications, it is impossible to definitively determine the advantage of any surgical method for the correction of lumbar deformity of the chest. The number of Nuss surgeries has been increasing over the years, which means that the minimally invasive approach is the method of choice for patients and surgeons, although questions remain about achieving structural stability and the method of Nuss correction in severe deformities. The lack of definitive conclusions is more related to the methodological problems of the analyzed data, including a limited number of observations and a large age difference in the observation groups, the lack of a standard for presenting data to describe the patient's condition (magnitude and type of deformity, primary complications of the cardiac and respiratory systems, the presence of complicating factors).