Overview1,2

Surgical treatment of pectus excavatum is intended to reduce pressure on vital organs and create a more normal chest shape by repositioning the chest including the ribs, sternum or “breastbone”, and the cartilage that connects the ribs to the breastbone.

Until the widespread adoption of the minimally-invasive Nuss Procedure during the 1990s, a surgery that is commonly referred to as the Ravitch Procedure was the most common surgical option for correction of pectus excavatum.

What is the Ravitch Procedure1,4

Adkins strut

This surgery corrects the shape of the chest by making a long cut, or incision, below the breast line across the chest. After the surgeon raises the chest muscles off the breastbone and ribs, he or she removes the abnormal cartilage, moves the breastbone into a normal position and places a short steel bar behind the breastbone to keep it in place. Surgery is performed while the patient is asleep under general anesthesia.  Following the 4 to 6 hour surgery, the cartilage will typically regrow and reconnect the breastbone to the ribs.

A Ravitch Procedure generally follows these steps:

  • An incision is made across the front of the patient’s chest.
  • Deformed cartilage is removed (resected) and the lining that covers the ribs and cartilage is left in place to help the cartilage grow back correctly.
  • A cut (osteotomy) is made in the breastbone so it can be raised to a flat position. The surgeon may use a metal bar or strut to support the breastbone in this position as it heals.
  • To help drain fluids out of the body, a tube is sometimes placed at the area of the repair.
  • The incision is closed at the end of the surgery.
  • After approximately 6 to 12 months, the metal support struts (if used), are removed through a smaller incision. 

What is the Nuss Procedure1,3

5

This 1- to 2-hour long surgery corrects the shape of the chest by using a curved metal bar that is placed under the breastbone. With the help of a small camera, the surgeon will create a pathway across the chest under the breastbone and insert a Pectus Support Bar. The bar is shaped to fit the patient’s anatomy and lifts the chest into a normal shape. As the bar pushes the breastbone forward, it lifts the cartilage that holds the breastbone to the ribs, reshaping the cartilage and creating a more normal shape. Surgery is performed while the patient is asleep under general anesthesia.

NussProcedurewithbar

A Nuss Procedure generally follows these steps:

  • Two small incisions (usually 2 inches in length), one on either side of the chest, are made to provide access under the sternum. Exact position of the incisions can vary depending on whether the patient is male or female.
  • A video camera used for surgery (called a thoracoscope) is inserted through a third small incision on one side below the others.
  • While using the camera to see inside the chest, a curved introducer instrument is used to create a pathway across the chest below the breastbone.
  • A metal bar shaped to fit the patient, called a Pectus Support Bar, is placed in the pathway under the sternum and then rotated to lift the chest and correct the deformity.
  • The video camera is removed and all incisions are closed at the end of the surgery.
  • After approximately 2 to 3 years, the Pectus Support Bar is removed through a small incision on the patient’s side.
  1. https://medlineplus.gov/ency/article/002949.htm
  2. https://www.pectus.com/learn/pe
  3. Nuss, Donald, and Robert E. Kelly. "The Minimally Invasive Repair of Pectus Excavatum." Operative Techniques in Thoracic and Cardiovascular Surgery 19.3 (2014): 324-347.
  4. Singhal, Sunil, and John C. Kucharczuk. "Total Pectus Excavatum Repair: Open Approach." Operative Techniques in Thoracic and Cardiovascular Surgery 19.3 (2014): 348-364.

 

 

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