The Ravitch procedure is done through a larger incision across the mid chest. The deformed cartilages attaching the ribs to the lower breastbone is removed, thus allowing the sternum to move forward in a more normal position. In order to keep the sternum elevated in the desired position a temporary metal bar may need to be placed. In certain patients, a break in the sternum is done to allow the sternum to be positioned forward. These supports are removed in 6 to 12 months. The Ravitch procedure takes approximately 4-6 hours.
The Nuss Procedure (minimally invasive technique)
During the Nuss procedure a small incision is made at the right side of the chest wall to insert a camera allowing the surgeon to monitor and avoid injury to the heart during insertion. Through two other small incisions on either side of the chest, a curved steel bar (individually curved for each patient) is inserted under the breastbone in order to push the sternum forward into the new position. The steel bar is then fixed to the ribs on either side. A small steel grooved plate may be used at the end of the bar to help stabilize and attach the bar to the rib. The bar is not visible from the outside and stays in place for 2-3 years. The bar is then surgically removed. The Nuss procedure takes between 1–2 hours.
Pros and cons: Nuss vs Ravitch
Whereas the Ravitch Procedure offers less pain after the procedure, the Nuss procedure gives a better cosmetic result. Dr. Hans Pilegaard primarily uses the Nuss procedure as it is the best option for most patients with pectus excavatum – even for patients older than 30 years. The operating time for the Nuss procedure is shorter and we experience reduced risk of infection and bleeding with the minimal invasive technique.
The Nuss procedure has several advantages over the Ravitch procedure in the immediate postoperative period.