DOI QR코드

DOI QR Code

Long-term Surveillance Comparing Satisfaction between the Early Experience of Nuss Procedure vs. Ravitch Procedure

  • Kang, Chang Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Park, Samina (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Park, In Kyu (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Young Tae (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Joo Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2011.12.28
  • Accepted : 2012.04.28
  • Published : 2012.10.05

Abstract

Background: Long-term surveillance comparing satisfaction between the early experience of Nuss procedure vs. Ravitch procedure. Materials and Methods: A total of 100 patients that underwent surgical correction of a pectus excavatum between 2001 and 2004 and were followed for ${\geq}2$ years were included. Surveillance on the degree of satisfaction was performed using five-levels of the Likert scale and self-assessment scoring. Results: Nuss or Ravitch surgery was performed in 63 and 37 patients, respectively. The Nuss procedure required a shorter operation time and shorter hospital stay than the Ravitch procedure (p<0.001). The surveillance demonstrated that 17.6% of the Nuss group and 35.7% of the Ravitch group were not satisfied with the outcome of the surgery (p=0.072). The most common causes of dissatisfaction were redepression in the Nuss group (n=5) and incomplete correction in the Ravitch group (n=7). The multivariate analysis showed that reoperation and a high postoperative pectus index were significant risk factors for a low satisfaction score. Conclusion: The Nuss procedure had several advantages over the Ravitch procedure in the immediate postoperative period. However, the long-term satisfaction was determined by a complete correction without recurrence or need for re-intervention rather than by the operation type.

Keywords

References

  1. Fokin AA, Steuerwald NM, Ahrens WA, Allen KE. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg 2009;21:44-57. https://doi.org/10.1053/j.semtcvs.2009.03.001
  2. Cartoski MJ, Nuss D, Goretsky MJ, et al. Classification of the dysmorphology of pectus excavatum. J Pediatr Surg 2006;41:1573-1581. https://doi.org/10.1016/j.jpedsurg.2006.05.055
  3. Koumbourlis AC. Pectus excavatum: pathophysiology and clinical characteristics. Paediatr Respir Rev 2009;10:3-6. https://doi.org/10.1016/j.prrv.2008.12.002
  4. Coln E, Carrasco J, Coln D. Demonstrating relief of cardiac compression with the Nuss minimally invasive repair for pectus excavatum. J Pediatr Surg 2006;41:683-686. https://doi.org/10.1016/j.jpedsurg.2005.12.009
  5. Johnson JN, Hartman TK, Pianosi PT, Driscoll DJ. Cardiorespiratory function after operation for pectus excavatum. J Pediatr 2008;153:359-364. https://doi.org/10.1016/j.jpeds.2008.03.037
  6. Lawson ML, Mellins RB, Tabangin M, et al. Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure. J Pediatr Surg 2005;40:174-180 https://doi.org/10.1016/j.jpedsurg.2004.09.040
  7. Malek MH, Berger DE, Housh TJ, Marelich WD, Coburn JW, Beck TW. Cardiovascular function following surgical repair of pectus excavatum: a metaanalysis. Chest 2006;130: 506-516. https://doi.org/10.1378/chest.130.2.506
  8. Kelly RE Jr, Cash TF, Shamberger RC, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. Pediatrics 2008;122:1218-1222. https://doi.org/10.1542/peds.2007-2723
  9. Lam MW, Klassen AF, Montgomery CJ, LeBlanc JG, Skarsgard ED. Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures. J Pediatr Surg 2008;43:819-825. https://doi.org/10.1016/j.jpedsurg.2007.12.020
  10. Haller JA Jr, Scherer LR, Turner CS, Colombani PM. Evolving management of pectus excavatum based on a single institutional experience of 664 patients. Ann Surg 1989;209: 578-582. https://doi.org/10.1097/00000658-198905000-00010
  11. Davis JT, Weinstein S. Repair of the pectus deformity: results of the Ravitch approach in the current era. Ann Thorac Surg 2004;78:421-426. https://doi.org/10.1016/j.athoracsur.2004.03.011
  12. Fonkalsrud EW, Dunn JC, Atkinson JB. Repair of pectus excavatum deformities: 30 years of experience with 375 patients. Ann Surg 2000;231:443-448. https://doi.org/10.1097/00000658-200003000-00019
  13. Mansour KA, Thourani VH, Odessey EA, Durham MM, Miller JI Jr, Miller DL. Thirty-year experience with repair of pectus deformities in adults. Ann Thorac Surg 2003;76: 391-395. https://doi.org/10.1016/S0003-4975(03)00441-7
  14. Croitoru DP, Kelly RE Jr, Goretsky MJ, Lawson ML, Swoveland B, Nuss D. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg 2002;37:437-445. https://doi.org/10.1053/jpsu.2002.30851
  15. Hosie S, Sitkiewicz T, Petersen C, et al. Minimally invasive repair of pectus excavatum--the Nuss procedure. A European multicentre experience. Eur J Pediatr Surg 2002;12:235-238. https://doi.org/10.1055/s-2002-34486
  16. Park HJ, Lee SY, Lee CS, Youm W, Lee KR. The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. Ann Thorac Surg 2004;77: 289-295. https://doi.org/10.1016/S0003-4975(03)01330-4
  17. Kim DH, Hwang JJ, Lee MK, Lee DY, Paik HC. Analysis of the Nuss procedure for pectus excavatum in different age groups. Ann Thorac Surg 2005;80:1073-1077. https://doi.org/10.1016/j.athoracsur.2005.03.070
  18. Dzielicki J, Korlacki W, Janicka I, Dzielicka E. Difficulties and limitations in minimally invasive repair of pectus excavatum: 6 years experiences with Nuss technique. Eur J Cardiothorac Surg 2006;30:801-804. https://doi.org/10.1016/j.ejcts.2006.08.004
  19. Coelho Mde S, Silva RF, Bergonse Neto N, et al. Pectus excavatum surgery: sternochondroplasty versus Nuss procedure. Ann Thorac Surg 2009;88:1773-1779. https://doi.org/10.1016/j.athoracsur.2009.07.051
  20. Antonoff MB, Erickson AE, Hess DJ, Acton RD, Saltzman DA. When patients choose: comparison of Nuss, Ravitch, and Leonard procedures for primary repair of pectus excavatum. J Pediatr Surg 2009;44:1113-1118. https://doi.org/10.1016/j.jpedsurg.2009.02.017
  21. Nakaoka T, Uemura S, Yano T, Nakagawa Y, Tanimoto T, Suehiro S. Does overgrowth of costal cartilage cause pectus excavatum? A study on the lengths of ribs and costal cartilages in asymmetric patients. J Pediatr Surg 2009;44:1333-1336. https://doi.org/10.1016/j.jpedsurg.2008.09.023
  22. Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg 2010;252:1072-1081. https://doi.org/10.1097/SLA.0b013e3181effdce
  23. Park HJ, Jeong JY, Jo WM, et al. Minimally invasive repair of pectus excavatum: a novel morphology-tailored, patient- specific approach. J Thorac Cardiovasc Surg 2010;139: 379-386. https://doi.org/10.1016/j.jtcvs.2009.09.003
  24. Luu TD, Kogon BE, Force SD, Mansour KA, Miller DL. Surgery for recurrent pectus deformities. Ann Thorac Surg 2009;88:1627-1631. https://doi.org/10.1016/j.athoracsur.2009.06.008
  25. Lawson ML, Barnes-Eley M, Burke BL, et al. Reliability of a standardized protocol to calculate cross-sectional chest area and severity indices to evaluate pectus excavatum. J Pediatr Surg 2006;41:1219-1225. https://doi.org/10.1016/j.jpedsurg.2006.03.003

Cited by

  1. Modified Robicsek procedure for pectus excavatum in adult patients vol.18, pp.5, 2012, https://doi.org/10.1093/icvts/ivt555
  2. Körperbild bei kongenitaler Brustwanddeformität : Systematisches Review vol.60, pp.6, 2015, https://doi.org/10.1007/s00278-015-0059-y
  3. Quality of life improves after minimally invasive repair of pectus excavatum vol.23, pp.3, 2012, https://doi.org/10.1177/0218492314553442
  4. Validity and Reliability of the Turkish Version of the Nuss Questionnaire Modified for Adults vol.48, pp.2, 2015, https://doi.org/10.5090/kjtcs.2015.48.2.112
  5. Pectus Excavatum and Pectus Carinatum: Associated Conditions, Family History, and Postoperative Patient Satisfaction vol.49, pp.1, 2012, https://doi.org/10.5090/kjtcs.2016.49.1.29
  6. A 20-year review of pectus surgery: an analysis of factors predictive of recurrence and outcomes vol.23, pp.6, 2012, https://doi.org/10.1093/icvts/ivw263