When patients choose: comparison of Nuss, Ravitch, and Leonard procedures for primary repair of pectus excavatum

Antonoff, Mara B.; Erickson, Alexandra; Hess, Donavon J.; Acton, Robert D.; Saltzman, Daniel A.

doi:10.1016/j.jpedsurg.2009.02.017

Cited by 65 publications

(58 citation statements)

References 23 publications

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“…Proponents of the modified Ravitch claim lower cost, shorter hospitalization, and less postoperative pain. 38,46,53,54 It is ideal for patients who have a combination of PE and carinatum, significant asymmetry, or extensive defects involving the upper ribs and cartilage. A minimally invasive technique for repair was described by Nuss et al 42 in 1998.…”

Section: Surgical Repairmentioning

confidence: 99%

Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations

Jaroszewski¹,

Notrica²,

McMahon³

et al. 2010

The Journal of the American Board of Family Medicine

197

162

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Pectus excavatum (PE) is a posterior depression of the sternum and adjacent costal cartilages and is frequently seen by primary care providers. PE accounts for >90% of congenital chest wall deformities. Patients with PE are often dismissed by physicians as having an inconsequential problem; however, it can be more than a cosmetic deformity. Severe cases can cause cardiopulmonary impairment and physiologic limitations. Evidence continues to present that these physiologic impairments may worsen as the patient ages. Data reports improved cardiopulmonary function after repair and marked improvement in psychosocial function. More recent consensus by both the pediatric and thoracic surgical communities validates surgical repair of the significant PE and contradicts arguments that repair is primarily cosmetic. We performed a review of the current literature and treatment recommendations for patients with PE deformities. (J Am Board Fam Med 2010;23:230 -239.)

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Section: Surgical Repairmentioning

confidence: 99%

Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations

Jaroszewski¹,

Notrica²,

McMahon³

et al. 2010

The Journal of the American Board of Family Medicine

197

162

View full text Add to dashboard Cite

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“…The bias risk assessment showed that all studies had a low risk of bias [13][14][15][16][17][18][19][20][21] (Table 1). Studies have failed mainly on comparability between cases and controls and confirmation of the absence of the outcome at baseline.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…The use of different instruments to measure postoperative pain [13][14][15][16][17][18][19][20] and patient satisfaction 13,15,20 prevented these outcomes to be objectively evaluated. of the exposed of the exposed of the exposed of the exposed of the exposed the exposed the exposed the exposed the exposed the exposed Does not specify whether the outcomes are absent at the beginning of the study or if patients have previously been through the operative process.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence

Araújo

Penha

Westphal

et al. 2014

Rev. Col. Bras. Cir.

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Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.

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“…The rate of reoperation seconddary to bar migration or persistent deformity was significantly higher in the Nuss group (OR, 5.68 [95% CI, 2.51 -12.85]; p = 0.0001) [33]. The incidence of he- and 50% of patients in these groups requiring epidural analgesia, respectively (statistical significance not reported) [46]. Interestingly, Inge et al reported a similar use of prescription analgesics regardless of the surgical technique used, with greater than 75% of all patients requiring narcotics, ketorolac, and methocarbamolfor a period of less than 2 weeks [54].…”

Section: Comparison Of Treatment Modalitiesmentioning

confidence: 98%

“…Proposed advantages to the minimally invasive Nuss procedure includes shorter operative times, minimal blood loss of less than 90 mL, immediate postoperative extubation, avoidance of instability of the chest wall, maintenance of chest wall elasticity and absence of a large surgical incision, making the Nuss procedure more suited to address psychosocial issues associated with pectus deformity [37,41,44,45]. Disadvantages of this minimally invasive repair includes considerable analgesic requirement, a challenging postoperative course in regards to pain control, increased length of hospitalization, and longer and more severe limitations in activity when compared with the open Ravitch procedure [2,4,23,45,46]. A significant reduction in forced vital capacity (FVC) on pulmonary function tests after implantation of the pectus bar has been reported (p < 0.001), which is theorized to be due to the transient postoperative functional restriction of respiratory movements of the thorax by the pectus bar [47].…”

Section: Newer Treatment Modalitiesmentioning

confidence: 99%

Advances in the management of pectus deformities in children

Swergold¹,

Sridharan²,

Loukas³

et al. 2013

OJPed

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Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the association of pectus deformities with other skeletal abnormalities suggests that connective tissue disease may play a role in their pathogenesis. Clinical features of these deformities vary with severity, as determined by the Haller index and Backer ratio, but frequently include cardiac and respiratory abnormalities. Importantly, there exist profound psychosocial implications for children afflicted with these deformities, including but not limited to feelings of embarrassment and maladaptive social behaviors. These debilitating characteristics have prompted the development of novel medical and surgical corrective techniques. The correction of pectus deformities reduces the incidence of physiological complications secondary to chest wall malformation, while simultaneously improving body image and psychosocial development in the affected pediatric population. The Ravitch (open) and Nuss (minimally invasive) procedures remain the most frequently employed methods of pectus deformity repair, with no difference in overall complication rates, though individual complication rates vary with treatment. The Nuss procedure is associated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Postoperative pain management is markedly more difficult in patients who have undergone Nuss repair. Patients undergoing the Ravitch procedure require less postoperative analgesia, but have longer operation times and a larger surgical scar. The cosmetic results of the Nuss procedure and its minimally invasive nature make it preferable to the Ravitch repair. Newer treatment modalities, including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compression bracing (DCB) appear promising, and may ultimately provide effective methods of noninvasive repair. However, these modalities suffer from a lack of extensive published evidence, and the limited number of studies currently published fail to adequately define their long-term effectiveness.

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When patients choose: comparison of Nuss, Ravitch, and Leonard procedures for primary repair of pectus excavatum

Cited by 65 publications

References 23 publications

Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations

Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations

Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence

Advances in the management of pectus deformities in children

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