Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence

Revista do Colégio Brasileiro de Cirurgiões

Maria Elizete De Almeida Araújo¹  Anderson Da Paz Penha¹  Fernando Luiz Westphal¹  Marcus Tolentino Silva¹  Taís Freire Galvão¹ 

关键词: Funnel chest;    Evidence-based medicine;    Effectiveness;    Surgical procedures;    operative;    Tórax em funil;    Medicina baseada em evidências;    Efetividade;    Procedimentos cirúrgicos operatórios;   

DOI  :  10.1590/0100-69912014006004

来源: SciELO

【 摘 要 】

Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.

【 授权许可】

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