Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

Abstract

This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric = 0–21; adult 17–99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation.

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

“…These studies typically have small numbers of patients and cannot compare between techniques. Johnson and colleagues surveyed this literature in a systematic review, but given the substantial heterogeneity, were unable to perform a meta-analysis and thus could not meaningfully compare the two techniques (22). There are currently no randomized trials comparing these procedures.…”

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

“…However, both Nuss and Ravitch techniques for the repair of PE have repeatedly been in use today in its ever-increasing number still yet, data's comparing both techniques have been limited as various surgical centers routinely perform either of them as they are inexperienced to the other. 23 Despite the success rate of MIR technique in children which are richly reported in the various literature, extending this procedure to adolescents, adults, athletic persons, and asymmetric cases have remained a subject of discussion. 24 Recently, almost all modern techniques are based on the MRR technique, except the Nuss procedure with surgical indications for pectus repair been the cosmetic aspect of the deformity, physiological, psychological and or orthopedic postural defects, with the cosmetic aspects of utmost importance to female patients.…”

“…Notwithstanding, Sternal allogeneic bone grafts have proven to be an effective and biologically well-tolerated option for sternal replacement. 5,23,28 In addition, several reports have questioned the necessity of radiographic studies with the use of chest x-rays which are taken after instrumentation in or around the thoracic cavity which was driven by concerns for radiation exposure, particularly in the pediatric population with a retrospective study which demonstrated that the postoperative chest x-rays were unnecessary following bar placement unless respiratory symptoms were present. 29 Invariably also, cardiac magnetic resonance imaging is currently been the reference standard for anatomic and functional cardiac assessments as several PE defects are more than likely to impair right ventricular function.…”

Wang procedure: novel minimally invasive procedure for pectus excavatum children with low age

“…If the metal bar is put into their body, as its size and shape do not change with age, the growth of the chest will be restrained. It is because of these reasons that Nuss procedure is rarely used in low age patients, especially under 3 years old [3].…”