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J Indian Assoc Pediatr Surg. 2019 Oct-Dec;24(4):252-256. doi: 10.4103/jiaps.JIAPS_68_18.

Surgical Correction of Pectus Excavatum Using a Rib Graft Strut Following Excision of Costal Cartilages.

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Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.



A number of techniques are described for correction of pectus excavatum (PE). This article describes the experience with an innovative procedure which combines features from the Ravitch and Nuss procedures without using prosthetic material.


This cross-sectional study included 12 cases of PE from January 2000 to March 2017 managed by excision of deformed costal cartilages and support to the thoracic cage using an autologous free rib graft as a strut. Indication for surgery was Haller's Index above 3.2 with or without respiratory distress. Noncontrast computed tomography scans were done at 6 months after surgery to document the position of the strut and to see the final correction and new Haller's Index, respectively.


The male-to-female ratio was 2:1. Preoperative Haller's Index in all cases was >3.2 (range 3.25-14). The average age at surgery was 5 years and 8 months (range: 7 months-15 years). Mean duration of hospital stay was 11 days (range 5-16 days).The 11th rib was used commonly although in two cases, the 10th rib was used as the 11th rib was considered relatively short. Pericardial effusion requiring strut removal was seen in one case; in another case, removal of the rib was needed because of nonhealing of a delayed dehisced surgical wound. Others had an uneventful postoperative period. The mean postoperative Haller's Index was 2.75 (range 2.0-7).


This modified procedure using an autologous rib strut is technically feasible and reproducible even with limited facilities and gives excellent results.


Haller's index; Nuss procedure; Ravitch procedure; pectus excavatum; rib strut

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