Comparison of the Nuss versus Ravitch procedure for pectus excavatum repair: an updated meta-analysis

J Pediatr Surg. 2017 Oct;52(10):1545-1552. doi: 10.1016/j.jpedsurg.2017.05.028. Epub 2017 Jun 3.


Background/purpose: To evaluate surgical outcomes of Nuss versus Ravitch repair of pectus excavatum via a systematic review and meta-analysis.

Methods: Medline, PubMed, Cochrane, EMBASE, and Google Scholar databases were searched up to September 5, 2016 using the following search terms: pectus excavatum, funnel chest, Nuss; Ravitch, minimally invasive, and open surgery. Randomized controlled trials, two-arm prospective, and two-arm retrospective studies were eligible for inclusion.

Results: Nineteen studies were included with a total of 1731 patients: 989 treated with Nuss and 742 treated with Ravitch. The overall analysis revealed that patients in the Nuss group had significantly shorter operation time (pooled SMD=-2.83, 95% CI=-3.76 to -1.90, p<0.001) and less blood loss (pooled SMD=-1.68, 95% CI=-2.28 to -1.09, P<0.001) than the Ravitch group. However, the length of hospital stay was similar between groups (pooled SMD=-0.55, 95% CI=-1.44 to 0.35, p=0.230). These findings were similar in the subgroup analysis for randomized and non-randomized controlled studies. Complications were not assessed due to inconsistent reporting across the included studies.

Conclusions: Our meta-analysis demonstrate that the Nuss procedure has a shorter operative time and less operative blood loss than the Ravitch procedure while the postoperative length of stay was similar.

Levels of evidence: Level III.

Keywords: Funnel chest; Minimally invasive; Nuss; Open surgery; Pectus excavatum; Ravitch.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Blood Loss, Surgical / prevention & control
  • Female
  • Funnel Chest / surgery*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Minimally Invasive Surgical Procedures / methods*
  • Operative Time*
  • Reoperation
  • Thoracic Surgical Procedures / methods*
  • Thoracoplasty / methods
  • Treatment Outcome