title: Comparative pulmonary functional recovery after Nuss and Ravitch procedures for pectus excavatum repair: a meta-analysis.
abstract: BACKGROUND
  Pectus excavatum (PE) is a common chest wall malformation, with surgery being the only method known to correct the defect. Although the Nuss and Ravitch procedures are commonly used, there is no consensus as to whether surgical repair improves pulmonary function. We therefore investigated whether pulmonary function recovers after surgical repair, and if recovery is dependent on the type of procedure or time after surgery.
  
  
  METHODS
  Literature searches were performed using PubMed, EMBASE, Health Periodicals Database, and CNKI (Chinese National Knowledge Index) from January 1990 to December 2007. The following keywords were used: pectus excavatum, chest wall deformity, funnel chest, pulmonary function, respiratory, lung function, and pectus severity index. The primary outcome of interest was possible changes in pulmonary function following surgical repair.
  
  
  RESULTS
  Meta-analysis of 23 studies showed that, although there was evidence of statistically significant heterogeneity among studies (Chi-square, 17.11, p < 0.05), changes in pulmonary functional indices, including forced expiratory volume over 1 s (FEV1), forced vital capacity (FVC), vital capacity (VC), and total lung capacity (TLC), were similar 1 year after the Ravitch and Nuss procedures. Several years after surgery and bar removal, however, the changes in pulmonary functional indices significantly favored the Nuss procedure.
  
  
  CONCLUSIONS
  Pulmonary function tends to improve after the surgical correction of pectus excavatum. Although the Nuss procedure was not significantly better 1 year after surgery, long-term postoperative pulmonary function improvement was significantly better after bar removal.
authors.affiliation: Department of Thoracic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China. chenzhenguang@yahoo.com
authors.forename: Zhenguang
authors.initials: Z
authors.lastname: Chen
authors.forename: Ela Bella
authors.initials: EB
authors.lastname: Amos
authors.forename: Honghe
authors.initials: H
authors.lastname: Luo
authors.forename: Chunhua
authors.initials: C
authors.lastname: Su
authors.forename: Beilong
authors.initials: B
authors.lastname: Zhong
authors.forename: Jianyong
authors.initials: J
authors.lastname: Zou
authors.forename: Yiyan
authors.initials: Y
authors.lastname: Lei
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D005660:Funnel Chest / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012129:Respiratory Function Tests; D013906:Thoracoscopy / Q000379:methods*; D014109:Total Lung Capacity / Q000502:physiology; D014797:Vital Capacity / Q000502:physiology