21740 Reconstructive repair of pectus excavatum or carinatum; open

Name of the Procedure:

Reconstructive Repair of Pectus Excavatum or Carinatum; Open Surgery

• Common Names: Open Pectus Repair, Open Surgical Correction of Pectus Excavatum/Carinatum
• Medical Terms: Ravitch Procedure, Open Surgical Pectus Correction

Summary

The open reconstructive repair of pectus excavatum or carinatum is a surgical procedure to correct the malformation of the chest wall where the breastbone is sunken (pectus excavatum) or protruding (pectus carinatum). This surgery involves reshaping the cartilage and bones to achieve a more normal chest appearance and function.

Purpose

This procedure aims to:

• Correct chest deformities that can impair heart and lung function.
• Improve physical appearance and boost self-esteem.
• Alleviate symptoms such as chest pain, breathing difficulties, and exercise intolerance.

Indications

• Patients with moderate to severe pectus excavatum or carinatum.
• Individuals experiencing symptoms such as chest pain, respiratory issues, or cardiac dysfunction due to the chest wall deformity.
• Those desiring aesthetic correction for severe chest malformation.

Preparation

• Patients may be required to fast for 6-8 hours before the procedure.
• Discontinuation of certain medications such as blood thinners may be necessary.
• Pre-operative imaging tests, like CT scans or MRIs, and pulmonary function tests are often conducted to assess the condition and plan the surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A horizontal or vertical incision is made on the chest to access the breastbone and cartilage.
3. Resection: The abnormal cartilages are removed and the breastbone repositioned to a normal contour.
4. Stabilization: Metal bars or other devices may be temporarily placed to support and hold the breastbone in the new position.
5. Closure: The incision is closed with sutures, and dressings are applied to the wound.

Duration

The procedure typically takes around 3-4 hours, depending on the complexity of the deformity.

Setting

• The surgery is performed in a hospital operating room.

Personnel

• A team led by a thoracic or pediatric surgeon.
• Anesthesiologist to manage anesthesia.
• Surgical nurses and possibly a surgical technician.

Risks and Complications

• Common risks: Infection, bleeding, and pain at the incision site.
• Rare complications: Recurrence of deformity, bar displacement, pneumothorax (collapsed lung), or injury to heart/lungs.
• Management includes medications, additional surgical interventions, and regular follow-up.

Benefits

• Improved chest appearance and symmetry.
• Enhanced respiratory and cardiac function.
• Relief from pain and other symptoms associated with the deformity.
• Psychological benefits from improved self-image.

Recovery

• Hospital stay of about 4-7 days post-surgery.
• Pain management with medications.
• Limitation on strenuous activities for several weeks to months.
• Regular follow-up appointments to monitor healing and the position of the stabilizing bars, which may be removed after 6 months to a year.

Alternatives

• Minimally invasive repair (Nuss procedure) for pectus excavatum.
• Custom-fitted braces for pectus carinatum in less severe cases.
• Pros and cons: Minimally invasive techniques may have shorter recovery times and less post-surgical pain but might not be suitable for all patients. Braces are non-surgical but require long-term use and may not be effective for severe deformities.

Patient Experience

• During: The patient will be under general anesthesia, ensuring no pain or awareness during the procedure.
• After: Initial post-surgical pain managed with medications, discomfort around the incision, and temporary chest stiffness.
• Pain management: Pain relief is achieved through prescribed medications, and comfort measures are provided by the healthcare team to ensure patient well-being throughout the recovery process.