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Comparison of Nuss and Ravitch Procedure Repair of the Pectus Deformities

Murat Öncel¹, Güven Sadi Sunam¹, Bekir Tezcan², Kazım Gürol Akyol², Hüseyin Yıldıran¹

¹Selcuk University Medical Faculty Thoracic Surgery, Konya, Turkey

²Konya State Hospital, Konya, Turkey

 

Objective: Minimally invasive repair of pectus excavatum (MIRPE) and pectus carinatum (MIRPC) have gained wide acceptance during the last years. This study compares, retrospectively, the experience at 58 minimal invasive procedures, and 80 Ravitch repair.

Methods: Between 2004-2015, 49 PE (pectus excavatum) and 9 PC (pectus carinatum) patients underwent minimal invasive and 80 underwent Ravitch procedure. Ages were ranged 6 to 36 years (mean 17,2) for MIRPE, and 10 to 22 years (mean 17) for Ravitch. The mean pectus severity index was 3,2 for MIRPE and 4,7 for Ravitch.

Results: There were no deaths. Complications were occured in 4 patients for Ravitch and 8 for Nuss procedure. Preoperative echocardiography was noted 7.3% mild mitral valve prolapse for Ravich procedure and no cardiac abnormalities for Nuss procedure. Complications in Ravitch; pneumothorax in 5.1% heamothorax in 2.6%, chest discomfort in 57%, pleural effusion in 2.6%, and sternal hypertrophic scar in 27%; Nuss procedure had 3,7% wound infections, no pleural effusion,1,8% pneumothorax. Mean operating time was 2,5 hours for Ravitch and one hour for Nuss procedure. Mean hospitalization was 8 days for Ravitch and 4,6 days for Nuss procedure. Mean time of return to work or school was 15 days for Ravitch and 10 days for Nuss procedure. Two patients’ barr was removed because of displacement, and one barr was removed because of chest pain.

Conclusions: The Nuss procedure has several advantages over the Ravitch method. Especially with regard to the cosmetics of the surgical wound Ravitch has a longer operating time and increased hospital stay, and complication rate is higher than Nuss procedure.

Keywords: Pectus deformity, thorax, minimal invasive surgery