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Ravitch Procedure

sternum strut used for ravitch surgery

The Ravitch procedure is one of the two surgical treatments for pectus excavatum together with the Nuss Procedure. It dates long before the Nuss Procedure, officially being presented as a pectus repair procedure in 1949 and just like the Nuss, it was named after it’s creator, Dr. Mark Ravitch. Nowadays, it has evolved it a Modified-Ravitch, with the original method consider outdated. Patients usually undergo the open – invasive Ravitch surgery if they are not a good fit for the Nuss or their individual case is more susceptible for this type of operation.

How is the Ravitch Procedure performed ?

When performing this type of surgery, first an incision (cut) is made from one end of the chest to the other. Then, unlike with the Nuss, the cartilages which are causing the defect, are cut away and taken on each side and the sternum is fixed into it’s normal natural position. This procedure can be applied for both pectus excavatum and pectus canarium. If the patient is treated for pectus excavatum, them a metal bar (strut), or a mesh support structure (for more complex deformities) is placed under the sternum in order to maintain his newly formed shape. The removed cartilages regenerate themselves in the following 4-6 weeks period, depending on the individual, keeping the sternum in his new position.

 

sternum strut placement

 

 

When is the strut removed ?

The strut inserted during the more traditional Ravitch surgery is removed one-year post operation, considerably shorter that the nuss bars which stay inside the patient for two to three year period. The removal procedure time is around 60 minutes and the patient is usually released the same day 

 

Advantages of the Ravitch over Nuss

  • Unlike the Nuss, which was first established in 1987, The Ravitch procedure has a longer history and medical documentation of the long-term effects of the operation.
  • Up to 97% of the patients have reported to be satisfied with the final results of the operation.
  • Statistics show that once the procedure is completed, it highly unlikely for the deformity to re-occur.
  • More suited for asymmetrical pectus and older patients.
  • Complex individual cases of pectus excavatum which are sometimes not adequate for the Nuss procedure, can be treated successfully with the Ravitch.

Disadvantages of the Ravitch over Nuss

  • Because this is not a minimally invasive procedure, a large  scar
    scars left from ravitch procedure

    Scars from the invasive Ravitch surgery are much more visible than the minimally invasive Nuss

    from the incision is left on the chest, which can be an aesthetic problem for some of the patients. This can be treated with adequate creams and the incision itself fade away with time into a small, thin line.
  • Cartilages are physically removed from the body and the regenerating process can be painfull for some of the patients.
  • Because of it’s extensive nature, more blood is lost during the operation and in some rare cases blood transfusion is needed.
  • Physical activity can be restricted for up to several months as the cartilages need time to regrow and get firm.