Ravitch Procedure
Key Terms:
Invasive Surgery: An surgery that breaks the skin, like one that requires incisions or needles. Similarly, a non-invasive surgery does not involve tools that break the skin. A minimally-invasive surgery involves smaller incisions, and shorter recovery time than invasive surgery [1].
Sternum: A flat bone that lies in the middle front part of the rib cage, sometimes called the breastbone. In more complicated words, the breastbone "is a partially T-shaped vertical bone that forms the anterior portion of the chest wall centrally" [2]. In pectus excavatum, the breastbone is sunken into the chest.
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What is the Ravitch Procedure?
The Ravitch Procedure is an invasive surgery that was created over 60 years ago to treat pectus excavatum [3]. During the procedure, a large incision is made in the chest and bars are put in place to help reshape the sternum, cartilage is removed, and ribs are attached to the sternum [5]. While this procedure is technically possible for people of all ages, it is typically done on patients aged 13-22 [4]. Because the Ravitch technique is invasive, the Nuss procedure is almost always used instead.
During the Ravitch Procedure, an incision is made into the patient’s chest and the sternum is repaired. A bar is placed into the chest to help keep the sternum in place, and drains are placed under the skin to drain excess fluid [7]. In some cases, a chest tube is put in place to prevent lung collapse, then the incision is closed [6].
After the Ravitch Procedure, patients can expect to stay in the hospital for 3-5 days [6]. Patients are restricted from performing strenuous activities such as running, sports, lifting heavy objects, and school gym classes for several months. Additionally, there are restrictions on certain activities such as driving and riding in the front seat of a car due to potential injuries from airbags. Six to twelve months after the procedure, the bar holding the sternum in place is removed [5] [6].
What happens during the procedure?
What is recovery from the procedure like?
Why is the Ravitch Procedure used?
If used, the Ravitch is most often preformed for older individuals (when the bones are more calcified), when the pectus is asymmetrical, or when the deformity isn't responsive to the less invasive Nuss procedure [9]. The Nuss procedure is the most commonly used pectus treatment because it is a much less invasive procedure.
References
1. Minimally invasive surgery. (n.d.). Yale Medicine. https://www.yalemedicine.org/
conditions/minimally-invasive-surgery
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2. Altalib AA, Miao KH, Menezes RG. Anatomy, Thorax, Sternum. [Updated 2023 Jul 24].
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK541141/
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3. Blanco, F. C., Elliott, S. T., & Sandler, A. D. (2011). Management of congenital chest wall deformities.
Seminars in plastic surgery, 25(1), 107–116. https://doi.org/10.1055/s-0031-1275177
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4. Casas-Melley, A. T., M.D (Ed.). (n.d.). The Ravitch Procedure. Nemours
KidsHealth. https://kidshealth.org/en/parents/ravitch-procedure.html
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5. Pectus excavatum treatments. (n.d.). Stanford Medicine.
https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/
pectus-excavatum/treatments.html
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6. Ravitch procedure. (n.d.). Children's Hospital of Philidelphia.
https://www.chop.edu/treatments/
ravitch-procedure#:~:text=The%20Ravitch%20procedure%20involves%20an,it%20in%20the
%20desired%20position
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7. Buchwald, J., Ligarski, D., & Polewczyk, T. (2020). Long-term results after the
modified ravitch procedure performed in children and adolescents – a
one-time procedure without the need to use additional support of the
sternum. A retrospective study. Polish Journal of Cardio-Thoracic Surgery,
17(4), 173-177. https://doi.org/10.5114/kitp.2020.102336
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8. Davis JT, Weinstein S. Repair of the pectus deformity: results of the Ravitch approach in the current era. Ann Thorac Surg 2004
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9. Luu, T. D., Kogon, B. E., Force, S. D., Mansour, K. A., & Miller, D. L. (2009).
Surgery for recurrent pectus deformities. The Annals of Thoracic Surgery,
88(5), 1627-1631. https://doi.org/10.1016/j.athoracsur.2009.06.008