Perioperative outcomes of thoracoscopic versus non-thoracoscopic minimally invasive repair of pectus excavatum: a systematic review and meta-analysis.

Background: Pectus excavatum is the most common chest wall deformity, with the Nuss procedure being the preferred surgical approach for correction. However, the decision to use thoracoscopic assistance remains challenging. This study aimed to evaluate the perioperative outcomes of thoracoscopic-assisted versus non-thoracoscopic-assisted minimally invasive repair of pectus excavatum (TA-MIRPE vs. NTA-MIRPE).

Methods: A comprehensive search was conducted across PubMed, Medline, Embase, WOS, and CBM databases for studies published from 2010 to the present related to this topic. Meta-analysis was performed using RevMan 5.0 and STATA 15.0, with primary comparisons focusing on postoperative complications and the incidence of poor incision healing.

Results: Eighteen studies involving a total of 5933 patients were included in the analysis, with 1670 undergoing non-thoracoscopic surgery and 4263 receiving thoracoscopic surgery. The meta-analysis revealed that, compared to the NTA-MIRPE group, the TA-MIRPE group had longer operation times [SMD = 1.71, 95% CI (1.14, 2.28), P < 0.001] and extended postoperative hospital stays [SMD = 0.12, 95% CI (0.04, 0.20), P = 0.004]. However, the TA-MIRPE group showed a lower incidence of postoperative complications [OR = 0.48, 95% CI (0.35, 0.65), z = 4.63, P < 0.001] and higher patient satisfaction [OR = 1.88, 95% CI (1.32, 2.67), z = 3.51, P < 0.001].

Conclusion: While TA-MIRPE is associated with longer operation times and hospital stays, it offers greater patient satisfaction, reduces postoperative complications, and enhances surgical safety.