Efficacy Analysis of Modified Single-Incision Surgery for Repair of Pediatric Chest Wall Defects: A Retrospective Cohort Study.

Abstract

Aim: This study aims to compare the efficacy of modified single-incision surgery with that of traditional modified Ravitch surgery for the repair of pectus excavatum in pediatric patients.

Methods: In this retrospective study, we included patients who underwent surgical correction for sternal depression from January 2015 to December 2020 across four major medical centers. Patients were categorized into two specific groups on the basis of the surgical technique employed: the modified single-incision surgery group, which comprised patients treated using the novel single-incision approach, and the traditional modified Ravitch surgery group, which included patients who received the conventional Ravitch surgery with multiple incisions. This study only included patients in the age range of 10 to 18 years, diagnosed with moderate to severe pectus excavatum, and lacked remarkable comorbid conditions that could influence surgical outcomes. Comprehensive data on preoperative characteristics, intraoperative variables, and postoperative results were collected for analysis.

Results: The modified single-incision surgery group showed significantly lower mean blood loss, mean operating time, mean hospital stay, postoperative drainage rate, postoperative mean Haller index and mean Haller index after bar removal compared to the traditional modified Ravitch surgery group (p < 0.05). Furthermore, the surgical outcomes were significantly better in the modified single-incision surgery group (p = 0.010) than in the traditional modified Ravitch surgery group. The modified single-incision surgery group also had a significantly lower incidence of postoperative complications, including pneumothorax, pleural effusion, pulmonary infection, bar rejection, and bar flipping and displacement (p < 0.05), than the traditional modified Ravitch surgery group. The modified single-incision surgery group showed significantly greater improvement in sternal depression depth compared to the traditional modified Ravitch surgery group (p = 0.031). Corrected symmetry was significantly better in the modified single-incision surgery group (p = 0.037). The overall satisfaction of patients in the modified single-incision surgery group was significantly higher than that in the traditional modified Ravitch surgery group (p = 0.011).

Conclusions: The modified single-incision procedure for the treatment of pectus excavatum offers considerable advantages over the traditional modified Ravitch surgery. The findings of this study suggest that the modified single-incision procedure is a safe and effective alternative for the correction of pectus excavatum.