Ravitch Procedure

What is the Ravitch procedure?

The Ravitch procedure is an operation to correct pectus excavatum (sunken chest) or pectus carinatum (keel chest). This procedure involves removing cartilage from your child’s chest and putting their breastbone (sternum) in the correct position. This is an open operation, meaning that a surgeon opens your child’s chest wall to operate instead of just using small incisions.

This operation can improve physical symptoms like chest pain and shortness of breath. But it can also help with self-confidence and other psychological issues. Going through puberty is hard enough without the added stress of feeling like everyone is looking at your chest.

How common is the Ravitch procedure?

Pectus excavatum (the most common reason for a Ravitch procedure) happens in 1 in 300 to 1 in 1,000 people. The two main surgical procedures to address this rare disease are the Nuss procedure and the Ravitch procedure. The general trend nationally (in the U.S.) is that more children are having the Nuss procedure.

How should I prepare my child for the Ravitch procedure?

Researchers have found that when parents are anxious about their child’s surgery, their child is, too. Just being aware of this may help you plan what to say to your child before surgery. Calming and reassuring words and actions may soothe your child before surgery and make them less anxious. For example, you can assure them that they’ll be asleep and won’t feel pain during their surgery.

It may be helpful to explain to your child that they may need a computed tomography (CT) scan to assist their provider in planning their surgery. This is a painless, noninvasive scan.

Your child’s provider will tell you what time they need to stop eating and drinking before surgery. They’ll also discuss which pain control methods may be best for your child.

What happens during the Ravitch procedure?

The Ravitch procedure works by removing abnormal cartilage and returning your child’s sternum to a normal position. During the Ravitch procedure, a surgeon will:

1. Make a cut (incision) in your child’s chest.
2. Elevate the pectoralis muscles covering the ribs.
3. Remove the abnormal costal cartilages (rib cartilage) on each side of their sternum.
4. Raise their sternum up from its sunken position (or lower it for pectus carinatum) and secure it in the correct position.
5. Put a stainless steel bar under the sternum or plates on top of the sternum to maintain the appropriate position.
6. Close the pectoralis muscles and incisions over a drain.

How long does the Ravitch procedure take?

The Ravitch procedure takes about two to three hours.

What happens after the Ravitch procedure?

After surgery, your child will have drains in their chest to remove excess fluid and a catheter in their bladder to collect their urine (pee). They’ll probably only need the catheter for one or two days. A provider will remove drains from your child’s chest two or three days after surgery.

A provider will need to remove the support bar after at least one year. If a provider uses a plate, they don’t remove it. Your child will be able to go home the same day as this future procedure to remove the bar.

If your child’s provider puts in a plate they attach with screws, they don’t need to remove it in the future.

What are the benefits of the Ravitch procedure?

People who have a Ravitch procedure have an improved appearance when their chests don’t sink or stick out anymore. The procedure may also improve their heart and lung function by removing pressure on those organs. Multiple studies found that the metal bar moved out of place less often in people who had a Ravitch procedure compared to a minimally invasive Nuss procedure.

How successful is the Ravitch procedure?

The Ravitch procedure is a “gold standard” operation. It’s helped thousands of people over the past 60 years, with 97% of them getting good results.

What are the risks or complications of the Ravitch procedure?

Complications happen in less than 5% of people who have a modified Ravitch procedure. Complications include:

• Collapsed lung (pneumothorax).
• Partially collapsed lung (atelectasis).
• Fluid around your lungs (pleural effusion).
• Inflammation in your pericardium (pericarditis).
• Fluid buildup under your skin.
• Infection.
• Bar moving out of place.
• Recurrence (the condition happens again).

What is the recovery time for modified Ravitch surgery?

You can expect your child to be ready to leave the hospital three or four days after a Ravitch procedure. Receiving nerve cryoablation (freezing a nerve) during surgery for pain control can shorten their length of stay to less than three days. This adds to the surgery time, but greatly reduces the amount of pain medicine a child needs after surgery. Other pain medicines may include epidurals and intravenous (IV) or oral pill medications.

Before leaving the hospital, your child will need to be able to eat, use the bathroom and walk on their own while managing their pain well.

Ask your child’s provider when they can return to school. They’ll need to avoid playing contact sports for six to eight weeks while their chest heals, but will likely go back to school before then.

Follow-up appointments

You can expect your child to see their provider for checkups two weeks, three months and one year after leaving the hospital. The visits will include physical exams.

When should I call my healthcare provider?

After surgery, contact a healthcare provider if your child has:

• Signs of infection, like a fever.
• Pain they can’t manage with medication.
• Shortness of breath.

A note from Cleveland Clinic

Deciding on a surgery for your child isn’t easy, but neither is seeing them struggle with discomfort or self-image. Be an advocate for your child and ask questions about the procedures you’re considering. Listen to your child’s concerns and try to see the surgeries from their perspective. You don’t have to make this decision in one day. Take the time to talk about it as a family to decide what’s best.