Ravitch procedure vs nuss bar for repair of pectus excavatum-a meta-analysis.

Abstract

Purpose: Pectus excavatum is the most common congenital chest wall deformity. Multiple strategies exist for the surgical correction of pectus, two of the most frequently used are the Ravitch procedure or Nuss bar insertion. However, little high-level research exists to compare the outcomes and resource utilisation of these two techniques. This meta-analysis sought to compare the outcomes of the two surgical approaches. Method(s): A meta-analysis was conducted searching five medical databases from inception to April 2023. Search terms were "pectus excavatum" AND ("Nuss" OR "Ravitch" OR "minimally invasive" OR "Video Assisted Thoracoscopic Surgery" OR "minimally invasive" OR "Thoracotomy"). Randomised controlled trials, two-arm prospective, and two-arm retrospective cohort studies were eligible for inclusion. RevMan 5.3 was used for statistical analysis. Result(s): The literature search identified 5,947 potential studies. After removal of duplicate studies, and title, abstract and full text reviews 27 studies were eligible for inclusion. These studies included 7,379 patients; 5,520 undergoing Nuss bar insertion and 1,859 undergoing Ravitch procedures. There was no significant difference in post-operative length of stay between the two groups-Ravitch weighted mean average length of stay 6.19 days, compared to Nuss bar 6.14 days, standard mean difference -0.05 days (95% CI -1.57-1.47). Relative risk of re-operation was similar between Ravitch compared to Nuss bar (Relative Risk 0.71, 95% CI 0.32-1.57). Rates of infection also did not differ between the two groups (Relative Risk 1.15, 95% CI 0.66-1.99). Conclusion(s): Ravitch and Nuss bar correction of pectus excavatum are frequently performed procedures. This meta-analysis showed no significant difference in the hospital length of stay, need for reoperation or rates of infection between the two procedures. Both procedures may be undertaken with low rates of morbidity.Copyright © 2024