When Is the Ravitch Procedure for Pectus Excavatum Used?

What is pectus excavatum and pectus carinatum?

The Ravitch procedure is a surgical correction of the congenital chest deformities called pectus excavatum and pectus carinatum.
The Ravitch procedure is a surgical correction of the congenital chest deformities called pectus excavatum and pectus carinatum.

Pectus excavatum is a condition in which the sternum/breastbone or rib cage has an abnormal shape. This produces a caved-in or sunken appearance of the chest.

Pectus carinatum is a genetic disorder of the chest wall. It happens because of an unusual growth of the rib and breastbone (sternum) cartilage. The bulging gives the chest a bird-like appearance. That is why the condition is sometimes called pigeon breast or pigeon chest.

Both these conditions may be observed in diseases of the connective tissue such as Marfan’s syndrome and Ehlers Danlos syndrome.

When is the Ravitch procedure for pectus excavatum used?

The Ravitch procedure is a surgery to correct severe pectus carinatum and pectus excavatum. The Ravitch procedure for pectus excavatum and pectus carinatum is typically performed on 13- to 22-year-old patients.

What happens during the Ravitch procedure?

  • The Ravitch procedure is performed under general anesthesia. The procedure takes about 90 min. 
  • The Ravitch procedure involves an incision across the chest and the removal of the cartilage that causes the defect. 
  • The covering of the cartilage is preserved. The sternum is then placed in the normal position. 
  • If a patient is being treated for pectus excavatum, a small bar is inserted under the sternum to hold it in the desired position. 
  • The extent of the operation depends upon the severity of the patient’s condition. The cartilage will regenerate over the next four to six weeks, fixing the sternum in position. A small drain may be placed at the operation site to prevent a fluid collection or lung collapsing.

What happens after the Ravitch procedure?

  • After the Ravitch procedure, the patient may remain hospitalized for three-five days.
  • The length of hospitalization is mainly determined by pain management. There are multiple ways to control the pain.
    • Initially, intravenous (IV) pain medications will be used to control the pain.
    • When the patient is fit to eat orally, oral pain medications will be used.
  • The patient may have activity restrictions to avoid any unnecessary complication.
    • They may need to avoid strenuous activities or sports for several months while the cartilage is growing back.
  • After being discharged from the hospital, the patient may need to follow-up in two-four weeks.
  • For patients treated for pectus excavatum, the bar is removed approximately six months after the procedure.

What are the risks involved in the Ravitch procedure?

There are risks with any surgery, including bleeding, infection and problems with anesthesia (headache, drowsiness and nausea). Specific risks regarding the Ravitch procedure include

  • Pain that can last a month or more,
  • Fluid collection under the skin at the surgery site,
  • Fluid around the lungs or a collapsed lung,
  • Bars that move out of place,
  • Damage to the heart or lungs during the surgery and
  • Reoccurrence of pectus excavatum or pectus carinatum.

What is the outcome of the Ravitch procedure?

Patients who undergo surgery to correct pectus excavatum with the Ravitch procedure are generally satisfied with the outcome. Although most surgeries for pectus excavatum are performed around the growth spurt at puberty, many adults also have benefitted from pectus excavatum repair. 

Temporarily freezing the nerves to block pain (cryoablation) can help with the recovery and reduce postoperative pain for four-six weeks. Usually, it takes six months or more for a patient to return to all activities they did before the surgery. For approximately six weeks after the surgery, the patient should take all medicines as prescribed by the surgeon. 

Recommended breathing exercises should be continued until six months to prevent any complications.

Ravitch Procedure for Pectus Excavatum

Medscape Medical Reference (https://emedicine.medscape.com/article/1970167-overview)