Ravitch versus Nuss procedure for pectus excavatum: systematic review and meta-analysis

Abstract

Background: Pectus excavatum is the most common congenital chest wall deformity. The two most common surgical techniques for its correction are the modified Ravitch technique and the minimally invasive Nuss technique. Despite both procedures being used widely, data comparing them are scarce. Methods:We conducted a systematic review and meta-analysis of comparative studies to evaluate these procedures. A systematic search of the literature was performed from six electronic databases. Pooled metaanalysis was conducted using odds ratio (OR) and weighted mean difference (WMD).Results: A total of 13 studies comprising 1,432 pediatric (79.3%) and adult (20.7%) patients were identified, including 912 patients undergoing the Nuss procedure compared to 520 patients undergoing the Conclusions: These results suggest no difference between the Nuss and Ravitch procedures for pediatric patients, while in adults the Ravitch procedure resulted in fewer complications.

Features of Marfan syndrome not listed in the Ghent nosology – the dark side of the disease

“…However, more severe pectus defects, especially when coupled to scoliosis, can cause clinically consequential restrictive disease [177]. Less invasive and more customizable surgical options (e.g., vertical expandable prosthetic titanium ribs (VEPTR) magnetic rods, or Nuss bars) for both scoliosis and pectus deformities are now employed early in disease development leading to fewer complications and lung function stabilization in selected patients [178][179][180][181][182]. As yet, no long-term studies documenting stability or improvement in lung function with these newer interventions in the Marfan population are available.…”

Minimally invasive operation for costal arch deformity

“…When the costal arch deformity exists with other abnormalities, such as pectus excavatum and puctus carinatum, the deformity can be treated at the same time. The early used method was to remove partial rib arch, and then connect the residual cartilage structures [1]. In 2010, Bosgraaf and colleague introduced a technique for treatment of costal arch deformity after Nuss operation [3].…”

“…In all kinds of thoracic deformities, pectus excavatum and puctus carinatum are the relatively more common kinds [1]. Other deformities are rarely mentioned, and costal arch deformity is one of them.…”

“…This deformity exists at both sides of the rib arch and can be of different shapes (Fig 1), but it is always considered to be a part of other complex malformations, so it has been only treated by an affiliated operation by some surgeons [2,3]. In the early Ravitch surgery, the method was to remove the local costal cartilages and connect the remaining rib arch with the sternum [1]. In 2016, Park and colleagues [2] proposed an additional "magic string" technique to correct the costal arch protrusion in sandwich surgery, which was designed for complex thoracic malformations.…”

Pectus excavactum-insights into its diagnosis and the current treatment options along with its clinical outcomes: two case reports

“…2,[8][9][10] In addition, recent studies have suggested that minimal invasive repair of PE improves the quality of life, body image, and the patient's self-esteem. 15,16,[18][19][20] To engage in light physical exercise such as jogging and cycling slowly according to his pace Patient's information: A 12-year-old boy with his parents visited our department's pediatric cardiac and thoracic outpatient clinic at the province city hospital in the background of severe recurrent chest pain accompanied by chest tightness. The patient was tall, thin with clear consciousness denied any trauma to the chest and was also not on any medications and at the time of visit he was not in any acute distress what so ever.…”