Minimally Invasive Pectus Excavatum Repair / Nuss Procedure
What is pectus excavatum?
One of every 1000 children has a chest disorder known as pectus excavatum. This condition is also referred to as "funnel chest". In patients with pectus excavatum, the sternum (breast bone) appears sunken.
Pectus excavatum is usually noted in infancy or early childhood and may become more severe as the child gets older. The condition is caused by abnormal growth of the cartilages that attach the ribs to the sternum.
What are the symptoms of pectus excavatum?
The sunken sternum can put pressure on the heart and lungs. This can cause the patient to be short of breath or have difficulty breathing during activities such as running and playing. They may also have breathing problems with asthma-like symptoms.
Other problems may be present in a child with pectus excavatum, including heart abnormalities. In addition, the child may complain of chest pain. However, many children with pectus excavatum may not have any symptoms associated with the condition.
What is the treatment for pectus excavatum?
The treatment of pectus excavatum depends on the severity of the condition. In patients with a mild depression of the sternum and no symptoms, no treatment is necessary.
The patient should be observed over a period of time to determine if the condition worsens or if the patient begins to experience any symptoms. Exercises may be prescribed in an effort to strengthen muscles in the chest.
More severe cases of pectus excavatum and cases where the patient has symptoms may require surgical correction. This can be done using either a minimally invasive technique (sometimes referred to as the Nuss Procedure), or by open surgical repair.
During the minimally invasive procedure incisions are made on each side of the chest underneath the arm. Through these incisions a bar is placed from one side of the chest to the other.
The bar goes beneath the sternum, lifting it into a more normal position. The incisions at the sides of the chest are closed with dissolving stitches. Patients usually remain in the hospital for three to five days after the procedure.
While patients are in the hospital, pain management is a major focus of care. Postoperative pain can be controlled with a PCA or an epidural catheter which is placed while the patient is in the operating room.
The patient is usually sent home on several different pain medications, including narcotics and muscle relaxants, as well as an antiinflammatory medication such as ibuprofen.
What are the long-term outcomes following minimally invasive repair of a pectus excavatum?
Patients who undergo minimally invasive pectus repair are restricted from certain activities such as contact sports and heavy lifting for three months after the procedure. After that, patients may return to full activities as tolerated.
The surgical bar placed to correct the pectus excavatum is removed after it has been in place for two to three years. This procedure is performed in the operating room and patients are usually able to go home the day of surgery.
Studies have shown that recurrence of pectus excavatum is uncommon (5%).
Rev. 9/07
