The Institute of Chest Wall Surgery
Re-operation for A Patient Underwent Failed Ravitch Procedure
Medical History
The patient, an 18-year-old male, has had pectus excavatum since childhood. At the age of six, he underwent the Ravitch procedure, but the surgery was not successful, and the depression remained. In recent years, the worsening deformity has led to frequent breathing difficulties, prompting him to seek surgery to completely correct the chest wall deformity.
Preoperative Examination
The chest wall exhibits a depressed deformity, with an old vertical surgical scar in the center. The heart is significantly compressed and displaced towards the left thoracic cavity.
Surgical Overview
An incision was made along the old central scar, and two bars were inserted to perform the Wang procedure. The surgery was completed successfully in one hour, with the deformity being corrected and no complications occurring.
Related Photos
The Ravitch procedure is one of the standard procedures for treating pectus excavatum. While it offers many advantages, it also has notable drawbacks. The most significant one is that it is an open surgery, which can cause substantial trauma. Additionally, the outcomes of this procedure can sometimes be uncertain.
The patient's initial surgery left a long and unsightly scar in the center of the anterior chest wall. As the depression persisted after surgery, a second surgery was necessary.
After the Ravitch procedure, significant adhesions often form between the sternum and the mediastinal structures, greatly increasing the risk of the second surgery. If the Nuss procedure is used for the secondary correction, there is a high risk of heart damage during the placement of the bars due to these adhesions. Therefore, the Nuss procedure is not the ideal choice for reoperation.
In contrast, the Wang procedure places a bar above the bone structure of the chest wall rather than inside the chest cavity. This approach significantly reduces the risk of heart damage, making the surgery much safer.