Ravitch versus Nuss for Adolescent Pectus Carinatum: Multicenter Evidence to Guide Deformity-Specific Surgical Decision-Making

الملخص

Background: Pectus carinatum (PC) is a congenital malformation of the chest wall, affecting adolescent males predominantly and associated with psychosocial effects. In the Middle East, many studies address the same topic. Objective: To evaluate outcomes of modified Ravitch and Nuss procedures in Iraqi adolescents. Methods: A multicenter retrospective cohort study (2020–2025) involved 102 adolescents (12–18 years) who underwent PC correction using Ravitch (n=52) or Nuss (n=50) techniques. Procedure selection was based on the severity of deformity, rigidity of the chest wall, and expertise of the surgeon. Outcomes included operative time, hospital stay, complications, aesthetic results, and patient satisfaction (5-point Likert scale). A severity-stratified subgroup analysis was performed. Results: Baseline characteristics were comparable, although severe deformities were more frequent in the Ravitch group (65.4% vs. 16.0%, p<0.001). The Nuss procedure had a shorter operation time (65±15 vs. 85±20 minutes, p<0.001) and less hospitalization (1.5±0.4 vs. 2.1±0.6 days, p<0.001). The rates of complications were identical (13.5% vs. 14%; p=0.93). Severity-stratified analysis showed higher Nuss operation efficiency in moderate levels of deformities with comparable rates of complication and satisfaction at severity levels. Favorable aesthetic outcomes were obtained in 82.7% of Ravitch and 88% of Nuss, and more than 90% of patients were satisfied after two years of follow-up. Conclusions: The two techniques are safe and effective in PC correction, supporting the Nuss procedure for moderate deformities, and the Ravitch technique is preferred for severe or rigid cases.