Comparison between the extrapleural Nuss and modified Ravitch procedure for pectus excavatum repair

Objective: Pectus excavatum (PE) is the most common congenital chest wall deformity. We previously carried out an extrapleural Nuss procedure through a non-thoracoscopic extrapleural approach for PE repair. To assess the repair efficacy and safety of this modified procedure in a long follow-up period, comparison between the extrapleural Nuss method and the modiifed Ravitch procedure was performed.Methods: We selected 141 patients with PE to receive the modiifed Nuss or classic Ravitch procedure at our institution from 2008 to 2012. Atfer the second surgery for bar or Kirschner wire removal, clinical and prognostic outcomes were compared between two groups.Results:hTere were 87 patients in modiifed Nuss group and 54 in Ravitch group with an average age of 7.64 years. hTe operative time, blood loss and hospitalization time of modiifed Nuss procedure were signiifcantly lower than that in Ravitch group (P<0.05). With respect to cosmetic effcacy, the Haller index differences before and atfer receiving repair for PE showed no difference between two procedures. hTe overall complication rates of the modiifed Nuss and Ravitch surgery were 19.54% and 12.96% respectively. hTe most frequent complication was skin necrosis in Nuss group rather than pneumothorax and hemothorax in the Ravitch procedure.Conclusion:It suggested that the non-thoracoscopic extrapleural modiifcation of the Nuss procedure was a safe and less traumatic procedure for the correction of the PE in selected patients.