Functional and Aesthetic Outcomes of Patients Underwent Modified Ravitch Technique for Repair of Pectus Excavatum

Gamal A Farag; Ahmed M Omran; Sherif H Youssif; Ramadan S Abd Alaziz; Samir A Nematallah; Ahmed B Abd El Salam; Husseini F El Boraey; Osama I Ramadan; Tarek Zahra; Ahmed M Zeina

doi:10.47176/mjiri.38.95

Functional and Aesthetic Outcomes of Patients Underwent Modified Ravitch Technique for Repair of Pectus Excavatum

Med J Islam Repub Iran. 2024 Aug 20:38:95. doi: 10.47176/mjiri.38.95. eCollection 2024.

Authors

Affiliations

¹ Department of Cardiothoracic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt.
² Department of Plastic and Reconstructive Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt.
³ Department of Chest Diseases, Damietta Faculty of Medicine, Al-Azhar University, Egypt.
⁴ Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
⁵ Department of Diagnostic Radiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt.
⁶ Basic Dental Sciences Department, Faculty of Dentistry, Applied Science Private University, Amman, Jordan.
⁷ Histology Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt.
⁸ Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Mansoura University, Egypt.

Abstract

Background: Pectus excavatum is the most frequent congenital defect of the chest wall. Surgical treatment with modified Ravitch-type repair is recommended in patients with cosmetic dissatisfaction or considerable cardiopulmonary symptoms. We aimed to analyze the surgical, aesthetic, cardiopulmonary functions and patient satisfaction outcomes of modified Ravitch repair pre and postoperatively.

Methods: This was a prospective analysis of 13 pectus excavatum patients undergoing repair by modified Ravitch using a permanent titanium plate fixed with a screw from September 2021 to August 2023. Patients were included to relieve pressure on the heart and lungs if complaining of exercise intolerance, cosmetic impairment, shortness of breathing, chest pain, or psychological disturbance with an age range from 10 years to 30 years old. While patients who had received conservative or surgical treatment previously or patients with scoliosis, Marfan syndrome or bronchial asthma were excluded. At the 6-month postoperative visit, a postoperative satisfaction survey was conducted.

Results: The means of the age of patients (16.4 ± 2.36 years); operative duration (120 minutes); blood loss (200± 15.47 mL) and Haller index was (3.8± 0.35) preoperatively compared with less than 3.0 (2.7± 0.08 postoperatively; hospital stay (7 days). The most frequent complications were seroma in one patient (7.69%), postoperative bleeding in one patient (7.69%) and skin infection in one patient (7.69%) of patients. No recorded infection of the sternal plate or required operative re-exploration for infection. All patients were subjectively satisfied with the excellent surgical results. Exercise intolerance despite increased exercise performance was observed following surgery, including less sensation of dyspnea.

Conclusion: Modified Ravitch-type repair is a secure and reliable method for treating pectus excavatum with better relief of preoperative symptoms.

Keywords: Aesthetic; Cardiopulmonary; Modified Ravitch; Outcomes; Pectus excavatum.