What to Expect & FAQs Modified Ravitch Procedure-Pectus Carinatum Surgery (in adults)
Prior to Surgery
- Talk to your doctor about your medications/vitamins/herbs. Some may need to be discontinued up to a week prior to surgery.
- Discuss any possible bleeding disorders or other medical conditions that could impact surgery or anesthesia.
- You will receive a call from the hospital the afternoon (or early evening) on the day prior to surgery concerning arrival time and where to go.
- Do not have anything to eat or drink after midnight the night before the surgery (rare exceptions include medications for high blood pressure or epilepsy — discuss these vital medications with your doctor).
On the Day of the Surgery
- Do not have anything to eat or drink after midnight the night before surgery.
- Take only the medications that the surgeon or anesthesiologist has recommended (with a small sip of water).
- Blood samples are usually obtained on the day of surgery to check blood counts and blood types. For women, a urine pregnancy test may be performed.
After Surgery
You will usually be in the hospital for three to five days following the procedure.
- Pain is common after this surgery. Patients typically receive a combination of long-acting local anesthesia, oral pain medication, non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofren, IV pain medications, and multi-level intercostal nerve blocks.
- Tubes may be inserted at the incision sites to help drain fluid from the chest. They will remain in place until the drainage decreases significantly.
- After surgery, you will be encouraged to sit up in bed, take deep breaths and walk for short distances.
- You should not bend, twist or turn (at first) so that the bar has time to set in place.
- You can usually shower two days after any drains are removed.
Recovery: What to Expect in the Next Few Weeks
Most patients take pain medications for the first 2-4 weeks. Usually it takes a month or two to fully recover and resume normal activities. Your surgeon can advise as to what activities are allowed.
Questions & Answers
Below, find answers to common questions. Click each item to expand the Q&A for each section.
After receiving general anesthesia, for an “open” (Ravitch-type) correction, the surgeon will usually make a transverse (horizontal) incision across the front of the chest and elevate some of the chest muscles off of the ribcage. Abnormal cartilages (and some ribs) are then removed. The sternum may be cut to allow it to flatten down onto the chest better. A temporary support bar may or may not be placed to stabilize the chest as the bones heal. The muscles are then closed over the sternum and the skin is closed with dissolvable sutures. For those patients having a “minimally-invasive” pectus carinatum repair, the surgeon makes two small lateral incisions on each side of the chest. Using a thoracoscope (small diameter telescope) to visualize the inside of the chest, a C-shaped bar is inserted subcutaneously through the lateral incisions. The bar is located at the point of maximum protrusion, placed in front of the sternum and fixed in a compressing position to the ribs on either side. The bar is normally removed after two to three years as an outpatient procedure.
For the “open” procedure, a single transverse incision is typically used. For the “minimally-invasive” approach, two small lateral incisions are made on either side of the chest to insert the bar. Small incisions (5 mm or less) are used for telescope insertion and/or drain placement.
Typically, patients stay three to five days in the hospital. However, some patients can be discharged home after only two days, and others (with more complex operations) may stay longer.
Patients often need pain medication for the 2-4 weeks. It typically takes a month or two for you to fully recover and resume normal activities. Your surgeon can advise you on what activities are allowed.