Original article: general thoracic
Repair of the pectus deformity: Results of the Ravitch approach in the current era

https://doi.org/10.1016/j.athoracsur.2004.03.011Get rights and content

Abstract

Background

Recent publications have advocated a minimally invasive approach to repair of the pectus deformity. Efforts to evaluate this new approach have been hampered by lack of comparative information regarding outcomes of the standard Ravitch approach. We use a modified Ravitch procedure, and present our series as a basis for comparison.

Methods

Records of 69 consecutive patients undergoing repair of the pectus deformity were retrospectively reviewed. Modifications included a minimal incision and a new technique to address sternal angulation. A patient satisfaction survey evaluated the patients' perception of the outcome.

Results

We found one wound infection (1.4%). Five patients (7.2%) had a seroma, and were treated as outpatients. Because the minimally invasive approach is used for pectus excavatum, we divided our series into excavatum and carinatum subsets. The subset of 44 pectus excavatum patients had a mean postoperative length of stay (LOS) of 2.9 days. The median patient satisfaction score was 4 on a scale of 1 to 5, at an average of 4.75 years after repair. The subset of 25 pectus carinatum patients had a mean LOS of 2.4 days and a median patient satisfaction score of 5.

Conclusions

The modified Ravitch procedure yields excellent results with low morbidity, hospital LOS, and cost, combined with high patient satisfaction. These current data will be useful for comparison as newer techniques for pectus repair continue to evolve.

Section snippets

Patients and methods

Office records of the Department of Cardiothoracic Surgery at Children's Hospital in Columbus, Ohio were retrospectively reviewed for all patients undergoing repair of the pectus deformity from July 1991 through July 1, 2003. Operative notes and clinical data were reviewed for each patient including severity grading of the deformity. For reasons discussed below, we did not use preoperative CT scanning as an evaluation tool. The severity was expressed as a numerical expression of one observer's

Patient information

Records were sufficient for analysis in all 69 patients. Fifty-eight (84%) of the patients were male and 11 (16%) were female. Figure 1 shows the distribution of age at the time of surgery (median 14.5 years). All patients were made aware of both the Nuss and Ravitch approaches and the discussion included relative risks and benefits.

Indications for surgery are shown in Figure 2. In 26% of patients chest wall pain was the primary indication. In most cases, the pain was not consistently related

Comment

Many aspects of the repair of the pectus deformity remain controversial. Because evidence is conflicting concerning the pathophysiology of the deformity, consensus has never been reached about the indications for surgery. Unclear indications for surgery have led to difficulty in scientifically evaluating the outcomes after surgery. With the continuing development of different modalities of treatment in different centers, comparisons are difficult and further conclusions are elusive.

Our policy

Acknowledgements

The authors acknowledge the invaluable assistance of Mary Lou Naftzger for database analysis as well as Georgiana Roberts and Silva Gramlich for financial analysis and assistance. Anthony Baker provided Figure 4.

References (20)

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