Modified Nuss procedure in patients with recurrent pectus excavatum following the Ravitch procedure with a retained strut: report of two cases.

BACKGROUND: Pectus excavatum is a prevalent congenital chest wall deformity that is often treated using surgical methods such as the Ravitch or Nuss procedures. Although both techniques are effective, recurrence is possible. We present two cases of recurrent pectus excavatum in patients who had undergone Ravitch procedures during childhood, with retained struts identified during evaluation > 15 years later. These patients underwent repair using the Nuss procedure. CASE PRESENTATION: Two adult patients with a history of pectus excavatum treated using the Ravitch procedure in their childhood experienced deformity recurrence. Evaluation revealed that the struts from their original Ravitch surgeries remained in place. Corrective surgery was performed using the modified Nuss procedure. Preoperative imaging and careful intraoperative planning were critical in addressing the existing struts and ensuring the correct placement of the replacement Nuss bars. Both patients underwent the procedure successfully without any intraoperative complications. Their postoperative recovery was smooth, with marked improvement in their chest wall deformities and enhanced quality of life. CONCLUSIONS: These cases underscore the viability of the Nuss procedure in treating recurrent pectus excavatum in patients who have previously undergone the Ravitch procedure, even if retained struts are present. Meticulous preoperative planning and surgical techniques are essential to managing the challenges posed by previous surgeries and hardware retention. The Nuss procedure can provide effective solutions in complex cases. However, further research is required to investigate the long-term outcomes of this approach.