When you look at your child's chest, does it look like it's sunken inward? Or is it protruding forward like a pigeon? Have you noticed that your child has difficulty breathing or chest pain because of this condition? Maybe he's reluctant to play with friends or go to a swimming pool, and he's very upset about this change in his body. Today we're talking about a special surgery that can help with such a condition.
What is the Ravitch Procedure?
Simply put, the Ravitch procedure is a surgical procedure to correct a pectus excavatum or a pectus carinatum. In this procedure, a surgeon opens your child's chest (open surgery), removes some of the deformed cartilage around the middle of the chest, the sternum , and repositions the sternum.
This surgery greatly reduces the physical discomforts that the child experiences, such as difficulty breathing and chest pain . But even more important is the relief it provides for the child's mental health. Imagine how frustrating it is for a young child to feel that their chest shape is different from others'? After this surgery, when that appearance is restored, the child's self-confidence increases significantly.
How common is this surgery?
Pectus Excavatum is a common cause of chest wall deformity. This condition affects one in 300 people and one in 1,000 people. There are two main types of surgery to treat this condition. One is the Ravitch Procedure . The other is the Nuss Procedure . Although Nuss surgery is more common in some countries, the Ravitch procedure is a very reliable, gold standard operation that has been successfully performed on thousands of people around the world for more than 60 years.
How do you and your child prepare before surgery?
This is a very important part for you as a parent. Research has found that if parents are afraid or anxious before a child's surgery, the child will feel the same way. Therefore, it is a great strength for the child to remain as calm as possible.
You can calm your child down by saying these things:
- "You were completely asleep during the surgery, so you won't feel anything or feel any pain ."
- "The doctors will take good care of you, and we will be right there."
Perhaps to plan the surgery, your doctor will order a CT scan of your child's chest. Explain to your child that it is a painless, routine scan.
In addition, your doctor will clearly instruct you on when to stop eating and drinking before surgery, as well as methods for managing pain after surgery.
What exactly happens during the surgery?
This surgery usually takes about two to three hours. Let's briefly look at the main steps involved.
| Steps | A simple explanation of what is happening |
|---|---|
| 1. Applying a cut | The doctor makes a horizontal incision in the skin on the child's chest, above the sternum. |
| 2. Lifting muscles up | The muscles covering the chest bone (Pectoralis muscles) are gently lifted up and pulled aside. |
| 3. Removal of deformed cartilage | The deformed costal cartilages on either side of the sternum, which have caused the shape to change, are carefully removed. |
| 4. Sternum correction | It lifts a breastbone that has sunk in or lowers a breastbone that has protruded out, keeping it in the correct, proper position it should be. |
| 5. Installing a support | To keep the sternum in the correct position, a small bar made of stainless steel is placed underneath it or plates are placed on top. |
| 6. Stitching the incision | Finally, the muscles are returned to their original position and the skin incision is carefully sewn closed. |
What happens after the surgery?
After the surgery, two small drains will be placed in the child's chest wound to drain excess fluid. A catheter will also be placed to drain urine. Don't worry about these. The catheter will be removed in a day or two. The chest tube will be removed in about two to three days.
The most important thing is that the steel support bar that is placed inside the chest needs to be removed in a minor operation about a year later . But it is very simple, and the child can go home the same day. Sometimes, if plates are inserted that are fixed with screws, they do not need to be removed again.
Are there any risks or complications with this surgery?
As with any surgery, there are very small risks. But the good news is that the complication rate for the modified Ravitch procedure is less than 5% . That means 95 out of 100 cases will be completely resolved. Here are some of the possible complications.
| Possible complication | Simple explanation |
|---|---|
| Pneumothorax | Lung contraction. |
| Atelectasis | Collapse of part of the lung. |
| Pleural effusion | Fluid filling around the lungs. |
| Pericarditis | Swelling of the membrane covering the heart. |
| Infection | Wound or infection in the body. |
| Jumping off the bar | Movement from the fixed support. |
| Recurrence of the disease | The breast returns to its previous shape after a period of time (very rare). |
How long does it take to recover?
You can expect to be able to take your child home from the hospital three to four days after surgery. Sometimes, if a nerve cooling procedure (Nerve Cryoablation) is used to control pain during surgery, the hospital stay can be reduced to less than three days.
Before going home, the child:
- You need to be able to control the pain.
- You need to be able to eat and go to the bathroom alone.
- You should be able to walk a little.
Ask your doctor when you can go back to school. However, contact sports should be avoided until your chest is completely healed, which should take about 6 to 8 weeks .
After the surgery, the doctor will ask you to come back for a follow-up visit in two weeks, three months, and a year.
When do you need to call the doctor immediately?
If your child has any of the symptoms below after returning home, call your doctor immediately.
| If you have these symptoms after surgery, call your doctor immediately. | |
|---|---|
| Symptom | What to pay attention to |
| Signs of an infection | High fever, redness, swelling, or pus oozing from the wound. |
| Uncontrollable pain | The pain is so severe that it cannot be controlled with the painkillers given. |
| Difficulty breathing | The child has difficulty breathing or feels suffocated. |
Making the decision to have surgery for a child is not an easy thing for parents. But it is also difficult to watch your child suffer physically or mentally because of their appearance. So be your child's advocate. Talk to your doctor about any concerns or fears you have. Talk to your child, listen to what they are feeling. This is not a decision that can be made overnight. Talk to the family and decide what is best for everyone.
Take-Home Message
- The Ravitch Procedure is a very successful, years-old surgery to correct sagging or protruding breasts.
- This provides a good solution to both the child's physical difficulties (such as difficulty breathing) and mental difficulties (such as lack of self-confidence).
- It is very important for the child's mental preparation that the parents remain calm before the surgery.
- Recovery requires several days in the hospital and several weeks of rest at home, especially avoiding contact sports.
- Never hesitate to discuss any concerns or doubts you have with your child's doctor.
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