When patients choose: comparison of Nuss, Ravitch, and Leonard procedures for primary repair of pectus excavatum

Mara B. Antonoff, Alexandra E. Erickson, Donavon J. Hess, Robert D. Acton, Daniel A. Saltzman

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52 Scopus citations


Background/Purpose: Pectus excavatum is a common chest wall deformity, and several procedures have been developed for its correction. We allow patients to choose among Leonard, Nuss, and Ravitch procedures. This study aimed to determine which procedure most patients select and the resultant outcomes. Methods: Charts were reviewed of all pectus excavatum repairs performed for 4 years by a practice covering a university-based children's hospital. Procedure choice, operative time, length of stay, analgesia, fees, and complications were recorded. Results: The Ravitch procedure was chosen by 60.9% of our patients, Leonard procedure by 23.9%, and Nuss procedure by 15.2%. Operative times were not significantly different among the groups. The mean length of stay was 2.2 days (Ravitch), 1.5 days (Leonard), and 3.9 days (Nuss) (P < .005). Epidural analgesia/patient-controlled analgesia pump requirements were 50% (Ravitch), 5% (Leonard), and 100% (Nuss). The mean charges were $27,414 (Ravitch), $18,094 (Leonard), and $43,749 (Nuss) (P < .05). The overall complication rate was 16.3%. The complications among each group were as follows: Ravitch, 14.3%; Leonard, 9.1%; and Nuss, 35.7%. Conclusions: We allow patients to choose among Leonard, Ravitch, and Nuss procedures for repair of pectus excavatum. Most select the Ravitch procedure. Length of stay, fees, analgesic needs, and complication rate were highest among patients in the Nuss group; all of these variables were lowest in the Leonard group.

Original languageEnglish (US)
Pages (from-to)1113-1119
Number of pages7
JournalJournal of Pediatric Surgery
Issue number6
StatePublished - Jun 2009

Bibliographical note

Copyright 2009 Elsevier B.V., All rights reserved.


  • Chest wall deformity
  • Leonard
  • Nuss
  • Pectus excavatum
  • Ravitch


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