Objective: Pectus excavatum (PE) is the most common congenital chest wall deformity. We previously carried out an extrapleural Nuss procedure through a non-thoracoscopic extrapleural approach for PE repair. To assess the repair efficacy and safety of this modified procedure in a long follow-up period, comparison between the extrapleural Nuss method and the modified Ravitch procedure was performed. Methods: We selected 141 patients with PE to receive the modified Nuss or classic Ravitch procedure at our institution from 2008 to 2012. After the second surgery for bar or Kirschner wire removal, clinical and prognostic outcomes were compared between two groups. Results: There were 87 patients in modified Nuss group and 54 in Ravitch group with an average age of 7.64 years. The operative time, blood loss and hospitalization time of modified Nuss procedure were significantly lower than that in Ravitch group (P<0.05). With respect to cosmetic efficacy, the Haller index differences before and after receiving repair for PE showed no difference between two procedures. The overall complication rates of the modified Nuss and Ravitch surgery were 19.54% and 12.96% respectively. The most frequent complication was skin necrosis in Nuss group rather than pneumothorax and hemothorax in the Ravitch procedure. Conclusion: It suggested that the non-thoracoscopic extrapleural modification of the Nuss procedure was a safe and less traumatic procedure for the correction of the PE in selected patients.