{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:33:45Z","timestamp":1761896025356},"reference-count":30,"publisher":"FapUNIFESP (SciELO)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Col. Bras. Cir."],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:p>Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.<\/jats:p>","DOI":"10.1590\/0100-69912014006004","type":"journal-article","created":{"date-parts":[[2015,2,25]],"date-time":"2015-02-25T15:58:31Z","timestamp":1424879911000},"page":"400-405","source":"Crossref","is-referenced-by-count":7,"title":["Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence"],"prefix":"10.1590","volume":"41","author":[{"given":"Maria Elizete de Almeida","family":"Ara\u00fajo","sequence":"first","affiliation":[{"name":"Federal University of Amazonas,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anderson da Paz","family":"Penha","sequence":"additional","affiliation":[{"name":"Federal University of Amazonas,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando Luiz","family":"Westphal","sequence":"additional","affiliation":[{"name":"Federal University of Amazonas,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus Tolentino","family":"Silva","sequence":"additional","affiliation":[{"name":"Federal University of Amazonas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ta\u00eds Freire","family":"Galv\u00e3o","sequence":"additional","affiliation":[{"name":"Federal University of Amazonas,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","reference":[{"issue":"6","key":"ref1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1093\/icvts\/ivs045","article-title":"Pectus excavatum: history, hypotheses and treatment options","volume":"14","author":"Brochhausen C","year":"2012","journal-title":"Interact Cardiovasc Thorac Surg."},{"key":"ref2","series-title":"UpToDate","volume-title":"Diseases of the chest wall","author":"Schwartzstein RM","year":"2012"},{"key":"ref3","series-title":"UpToDate","volume-title":"Pectus excavatum: Etiology and evaluation","author":"Mayer OH","year":"2011"},{"issue":"3","key":"ref4","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1590\/S0102-36162009000300003","article-title":"Abordagem ortop\u00e9dica das deformidades pectus: 32 anos de estudos","volume":"44","author":"Haje SA","year":"2009","journal-title":"Revista bras ortop."},{"issue":"3","key":"ref5","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1590\/S1806-37132009000300005","article-title":"Prevalence of pectus carinatum and pectus excavatum in students in the city of Manaus, Brazil","volume":"35","author":"Westphal FL","year":"2009","journal-title":"J Bras Pneumol."},{"issue":"3","key":"ref6","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1053\/j.sempedsurg.2008.03.002","article-title":"Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation","volume":"17","author":"Kelly RE Jr","year":"2008","journal-title":"Semin Pediatr Surg."},{"issue":"6","key":"ref7","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s00383-011-2854-z","article-title":"Body-image, self-concept and mental exposure in patients with pectus excavatum","volume":"27","author":"Hadolt B","year":"2011","journal-title":"Pediatr Surg Int."},{"issue":"4","key":"ref8","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.thorsurg.2010.07.002","article-title":"Indications and technique of Nuss procedure for pectus excavatum","volume":"20","author":"Nuss D","year":"2010","journal-title":"Thorac Surg Clin."},{"key":"ref9","series-title":"The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses","author":"Wells GA","year":"2011"},{"key":"ref10","series-title":"Diretoria de Normas e Habilita\u00e7\u00e3o de Produtos - DIPRO. 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Framing the question and deciding on important outcomes","volume":"64","author":"Guyatt GH","year":"2011","journal-title":"J Clin Epidemiol."},{"key":"ref23","first-page":"CD008889","article-title":"Surgical interventions for treating pectus excavatum","author":"Silva MVM","year":"2010","journal-title":"Cochrane Database Sys Rev."},{"issue":"7","key":"ref24","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1007\/s00268-011-1111-x","article-title":"The quality of life after bar removal in patients after the nuss procedure for pectus excavatum","volume":"35","author":"Kim HK","year":"2011","journal-title":"World J Surg."},{"issue":"2","key":"ref25","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.ejcts.2010.02.018","article-title":"Postoperative pain location following the Nuss procedure-what is the evidence and does it make a difference?","volume":"38","author":"Pilegaard HK","year":"2010","journal-title":"Eur J Cardiothorac Surg."},{"issue":"1","key":"ref26","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1055\/s-0031-1275177","article-title":"Management of congenital chest wall deformities","volume":"25","author":"Blanco FC","year":"2011","journal-title":"Semin Plast Surg."},{"issue":"4","key":"ref27","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1093\/ejcts\/ezs130","article-title":"How early can we repair pectus excavatum: the earlier the better?","volume":"42","author":"Park HJ","year":"2012","journal-title":"Eur J Cardiothorac Surg."},{"issue":"2","key":"ref28","first-page":"334","article-title":"Extending the use of Nuss procedure in patients older than 30 years","volume":"40","author":"Pilegaard HK","year":"2011","journal-title":"Eur J Cardiothorac Surg."},{"issue":"1","key":"ref29","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jpedsurg.2006.09.042","article-title":"Magnetic Mini-Mover Procedure for pectus excavatum: I. 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