Pectus excavatum repair is surgery to correct pectus excavatum. This is a deformity of the front of the chest wall that causes a sunken breastbone (sternum) and ribs.
Pectus excavatum is often called a funnel or sunken chest. It occurs at birth, and often gets worse during adolescence.
Funnel chest repair; Chest deformity repair; Sunken chest repair; Cobbler's chest repair; Nuss repair
There are two types of surgery to repair this condition -- open surgery and closed (minimally invasive) surgery. Both of these are done while the child is in a deep sleep and pain-free from general anesthesia.
Open surgery is more traditional. In this method, the surgeon makes a cut across the front part of the chest.
The second type of surgery is a closed, less invasive method (Nuss repair). It is used mostly for children. No cartilage or bone is removed.
The surgery may take 1 - 4 hours.
The most common reason for pectus excavatum repair is to improve the appearance of children who feel very self-conscious about the sunken look of their chest wall. Sometimes the deformity is so severe that it affects breathing, especially in adults later in life.
Some people may have difficulty exercising or pain that comes and goes.
Surgery is usually not done before age 6. Best results are seen when the surgery is done before adulthood.
Surgery is usually done on children who are 12 to 16 years old. It can also be done on adults in their early 20s.
The risks for any anesthesia are:
The risks for any surgery are:
Risks for this surgery are:
All patients need to have a complete medical exam and a variety of tests before the surgery. The surgeon will perform the following:
Always tell your child's doctor or nurse:
During the days before the surgery:
On the day of the surgery:
It is common for children to stay in the hospital for 1 week. How long your child stays will probably depend on the level of discomfort after surgery.
Pain is common after the surgery. For the first few days, your child may receive strong pain medicine in the vein (through an IV) or through a catheter placed in the spine (an epidural). After that, pain is usually managed with medicines taken by mouth.
Your child may have tubes in the chest around the surgical cuts. These tubes drain extra fluid that builds up and help the lungs expand. The tubes will remain in place until they stop draining, usually after a few days.
The day after surgery, your child will be encouraged to sit up, take deep breaths, and get out of bed and walk. These activities will help healing.
At first, your child will not be able to bend, twist, or roll from side to side. Activities will slowly be increased.
When your child can walk without help, he or she is probably ready to go home. Before leaving the hospital, you will receive a prescription for pain medicine for your child.
Improvements in appearance are usually good. Improvements in breathing or ability to exercise varies from patient to patient.
Tzelepis GE, McCool FD. The lungs and chest wall disease. In: Mason RJ, Murray JF, Broaddus VC, Nadel JA. Murray & Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 83.
Sugarbaker DJ, Lukanich JM. Chest wall and pleura. In: Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 57.