Table of ContentsView AllTable of ContentsWhat Is ItPurposeHow to PrepareWhat to ExpectRecovery
Table of ContentsView All
View All
Table of Contents
What Is It
Purpose
How to Prepare
What to Expect
Recovery
Pectus excavation surgery is done to correct a chest deformity present at birth in some individuals. Withpectus excavation, the sternum (breastbone) caves inward and gives the chest a sunken in appearance.
Mild cases do not require treatment, but pectus excavation surgery may be recommended when:
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What Is Pectus Excavatum Surgery?
There are two main types of pectus excavatum surgeries:
There is also an investigational approach for correcting pectus excavatum called themagnetic mini-mover procedure (3MP).
With this, magnets are implanted—one inside the chest and one outside the chest, which is attached to an external brace. The magnets create a magnetic force field that slowly pulls the chest to reconfigure it.
The effectiveness of this minimally invasive procedure is still being determined, as are logistical issues with the magnetic brace, which has been found to break in some patients.
The optimal timing for pectus excavatum surgery is 8 years of age through adolescence. Bones and cartilage are less pliable after that time period.That said, adults have successfully undergone this surgery.
Contraindications
The following may make pectus excavatum surgery inadvisable:
Doctors need to evaluate each patient individually to determine if this surgery can be recommended.
Potential Risks
Risks of any pectus excavatum surgery include:
Specific risks associated with the Nuss procedure include:
The main risk associated with the Ravitch procedure is acquiredJeune syndrome. With this, the lungs cannot grow to their adult size because of the restricted size of the chest wall, which may become damaged during surgery.
Purpose of Pectus Excavatum Surgery
The purpose of pectus excavatum surgery is to correct the chest deformity in order to alleviate symptoms related to the pressure being put on the heart and lungs. The extent of the deformity is measured using a calculation known as the Pectus Severity Index (PSI).
The surgery also improves the appearance of the chest.
Pectus excavatum surgery is generally indicated if two or more of the following criteria are met:
Progression of the pectus deformity is factored into the decision to proceed with surgery as well. Doctors also consider the extent to which the deformity may be impacting a patient’s mental health (e.g.,depressionor self-esteem issues related to appearance).
When pectus excavatum surgery is scheduled, various pre-operative tests will be ordered, including:
General anesthesia clearance, which often includes a detailed medical history and physical examination, is needed. Basic blood tests, like acomplete blood count (CBC), may also be done.
Once pectus excavatum surgery is scheduled, the surgeon will provide instructions on how to prepare.
Location
Pectus excavatum surgery is performed in a hospital.
Food and Drink
Avoid giving your child anything to eat or drink before surgery with the exception of clear liquids, which should be stopped two hours prior to the scheduled arrival time.
Medications
Certain medications must be stopped prior to surgery, includingnonsteroidal anti-inflammatory drugs (NSAIDs)and the diabetes drugmetformin.
Some surgeons ask their patients to start taking a stool softener one week prior to surgery to help reduce constipation.
A doctor needs to know about all of the drugs a patient is taking prior to surgery. This includes prescription and over-the-counter medications, herbal products, dietary supplements, vitamins, and recreational drugs.
What to Wear and Bring
Have your child wear something that is easy to remove, as they will need to change into a hospital gown upon arrival.
Creams, lotions, makeup, perfume, and cologne should not be used on the day of surgery.
Since your child will be staying multiple nights in the hospital, you will have to pack them an overnight bag or suitcase.
Consider the following items when packing:
At least one parent usually stays with their child in the hospital for support, so make sure to pack an overnight bag for yourself as well.
Pre-Op Lifestyle Changes
Adolescent and adult smokers should stop smoking as soon as possible prior to surgery. Smoking increases the risk for complications both during and after the procedure.
What to Expect on the Day of Surgery
Here is what you can generally expect on the day of your child’s pectus excavatum surgery. The same applies to adults undergoing this procedure.
Before the Surgery
Upon arrival at the hospital, your child will be led into a small holding area and given a hospital gown to change into. A nurse will then take and record theirvitals(body temperature, blood pressure, etc.)
At this time, an intravenous (IV) line may be placed into a vein in their arm or hand. This IV will be used for delivering medications during the procedure.
The doctor will then come to say hello and briefly review the surgery with you/your child. You may need to sign a consent form at this time.
Before going into the operating room, your child may be given a sedative to help them relax and, sometimes, fall asleep. Younger children may receive the sedating medication through a mask; older children/adolescents may receive it through their IV.
From there, your child will walk into the procedure/operating room or be wheeled there on a gurney.
Depending on theanesthesiologist’spreference, one parent or guardian may be allowed to accompany their child into the operating room for the start of anesthesia. For the remainder of the procedure, anyone accompanying the patient will need wait in the waiting room.
During the Surgery
The exact steps of the surgery depend on which procedure is being performed.
As an example, here is the general flow of the Nuss procedure:
After the Surgery
In the recovery room, a nurse will monitor your child’s vitals signs. Pain, nausea, and grogginess, common anesthesia-related symptoms, can be expected.
You/your child will stay in the recovery room until vitals are stable and the anesthesia has completely worn off.
When the nurse deems it appropriate, they will transport your child to a hospital room for what’s typically a three- to seven-night stay.
During recovery in the hospital, the surgical team may use different methods to help manage pain. These include:
Stool softeners orlaxativeswill be given to prevent constipation.
Deep breathing exercises will also be recommended to help preventpneumonia.
Aphysical therapistwill meet with your child to help them get from their bed to a chair the day after surgery. From there, they will work with your child to help them build up strength and start walking around the hospital room before going home.
Once discharged home, it’s important to adhere to post-operative instructions, which may include:
Wound Care
When to Call Your SurgeonCall your surgeon right away if any of the following occur:FeverRedness, swelling, drainage, or bleeding from the wound sitePersistent cough or trouble breathingInjury or trauma to the chestSudden or worsening chest painArm pain or numbnessPain not relieved with medication
When to Call Your Surgeon
Call your surgeon right away if any of the following occur:FeverRedness, swelling, drainage, or bleeding from the wound sitePersistent cough or trouble breathingInjury or trauma to the chestSudden or worsening chest painArm pain or numbnessPain not relieved with medication
Call your surgeon right away if any of the following occur:
Activity
There will be several activity restrictions for the first four to eight weeks or more after surgery.
Examples of such restrictions include having your child:
Your child will also need to refrain from having amagnetic resonance imaging (MRI)scan during this period.
Medical Alert Bracelet
During the time the metal bar is in place after pectus excavatum surgery, have your child wear amedical alert braceletthat states: “surgical steel bar in place under sternum.”
In the event of an emergency, this would inform first responders thatCPRneeds to be done with a more forceful compression of the chest. Likewise, it would tell them that the placement of paddles used for external defibrillation (shocks to the heart) needs to be adjusted.
Long-Term Care
Surgical repair of pectus excavatum has excellent success rates with most patients reporting an improvement in self-image and exercise tolerance.
Keep in mind, though—follow-up surgeon visits at regular intervals after surgery are necessary until the metal bar is eventually removed.
At these appointments, healing will continue to be monitored and activity limitations may be modified. ChestX-raysmay also be done to check the position of the bar.
Future Surgeries
A future same-day surgery to remove the metal bar will be performed around two years after the Nuss procedure and six months after the Ravitch procedure.
Possible future surgeries may also be needed if a complication arises from the initial surgery or if the deformity recurs.
A Word From Verywell
If your child has a sunken chest, it’s important to talk with their doctor, especially if they are experiencing physical or psychological symptoms as a result. A medical history, physical examination, and various tests on your child’s heart and lungs will help the doctor decide if surgery is needed.
If pectus excavatum surgery is recommended, continue to learn everything you can about surgical options. It’s also a good idea to reach out to loved ones or a support group for comfort and assistance during this understandably stressful time.
18 Sources
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