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Comparison of minimally invasive and modified Ravitch pectus excavatum repair
Eric W Fonkalsrud1, Steven Beanes, Andre Hebra
1Department of Surgery, UCLA Medical Center, Los Angeles, CA, USA.
Background/Purpose:
Minimally invasive repair of pectus excavatum (MIRPE) has gained wide acceptance during the last 4 years. This study compares, retrospectively, the experience at 2 large hospitals, 1 using MIRPE and the other a modified Ravitch repair (MRR).
Methods:
From 1996 to 2000, 68 PE patients underwent MIRPE at one hospital, and 139 underwent MRR at another hospital. Ages ranged from 5 to 19 years (mean, 12) for MIRPE, and 3 to 51 years (mean, 17.3) for MRR. The mean pectus severity index was 4.2 for MIRPE and 4.9 for MRR (normal, 2.5).
Results:
There were no deaths after MIRPE or MRR. Complications included 6 reoperations for MIRPE and none for MRR. There were 8 rehospitalizations for MIRPE and none for MRR. Ninety percent of MIRPE complications occurred in the first 25 cases. The mean blood loss was under 90 mL for both MIRPE and MRR. Mean operating time was 75 minutes for MIRPE and 212 minutes for MRR. Ninety-six percent of MIRPE patients and no MRR patients had epidurals. Intravenous analgesics averaged 5 days for MIRPE and 1.7 days for MRR. Mean hospitalization was 6.5 days for MIRPE and 2.9 days for MRR. Mean time before return to work or school was 18 days for MIRPE and 12 days for MRR. The sternal bar was removed from 107 of 139 MRR patients (mean time, 19 minutes) and 18 of 68 MIRPE patients (mean time, 25 minutes).
Conclusions:
Both MIRPE and MRR provide excellent clinical results. MRR has a longer operating time but decreased hospital stay, complication rate, and use of pain medications. Attention to technical operative details and surgeon's experience are essential for optimal results using both techniques.
Insights
Minimally invasive repair of pectus excavatum (MIRPE) and modified Ravitch repair (MRR) both yield excellent results for pectus excavatum. MRR shows fewer complications and shorter hospital stays, while MIRPE has a shorter operating time.
Area of Science:
- Thoracic surgery
- Pediatric surgery
- Surgical techniques
Background:
- Minimally invasive repair of pectus excavatum (MIRPE) has become increasingly popular.
- This study retrospectively compares MIRPE with modified Ravitch repair (MRR).
Purpose of the Study:
- To compare the clinical outcomes and resource utilization of MIRPE versus MRR.
- To evaluate complication rates and recovery times for both surgical procedures.
Main Methods:
- Retrospective comparison of 68 MIRPE patients and 139 MRR patients (1996-2000).
- Patient demographics, pectus severity index, operative details, and postoperative outcomes were analyzed.
Main Results:
- No mortality for either MIRPE or MRR.
- MIRPE had higher rates of reoperation (6) and rehospitalization (8) compared to MRR (0 for both).
- MRR demonstrated shorter mean hospitalization (2.9 days vs. 6.5 days) and faster return to work/school (12 days vs. 18 days) than MIRPE.
Conclusions:
- Both MIRPE and MRR achieve excellent clinical outcomes for pectus excavatum repair.
- MRR offers advantages in reduced hospital stay, lower complication rates, and decreased pain medication use.
- Surgical experience and meticulous technique are crucial for successful outcomes with both procedures.