Pectus excavatum (PE) is a common structural deformity of the anterior thoracic wall, with a male predominance and significant potential for cardiopulmonary and psychological consequences. Despite its prevalence, the decision to surgically intervene remains controversial due to a lack of reliable studies comparing operative to non-operative management in matched controls. The objective of this study was to review the best available literature and compile peri-operative data from pediatric patients on indications, outcomes and complications from the Nuss procedure. A literature search was conducted using a PICO question (“What are the indications and surgical outcomes of children who undergo pectus repair with the Nuss procedure?”), with a focus on English language papers from 1987 to 2022 and excluding conference materials and adult patients. Ultimately, 16 papers were chosen for inclusion based on the date of publication, the strength of the study, the quality of the evidence and the authors’ evaluation of their relevance to practicing physicians. The results showed that while there were no validated cardiopulmonary criteria to guide surgical decision-making, several studies reported statistically significant improvements in several physiological parameters, including FEV1, cardiac output, and cardiac index (p < 0.05 for all variables) after the Nuss procedure, but it remains controversial whether this condition is primarily a cosmetic disorder or not.