Navigate Up

Heart Center - A-Z Index

#
J
Q
X
Z

Print This Page

Pectus excavatum repair

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.

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 surgeon removes the deformed cartilage and leaves the rib lining in place. This will allow the cartilage to grow back correctly.
  • The surgeon makes a cut in the breastbone and moves it aside. The surgeon may use a rib or a metal strut (support piece) to hold the breastbone in this normal position until it heals. Healing will take 3 to 6 months.
  • The surgeon may place a chest tube to drain fluids that build up in the area.
  • Metal struts will be removed in 6 months through a small cut in the skin under the arm. This procedure is usually done on an outpatient basis.

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 surgeon makes two small cuts, one on each side of the chest. A curved steel bar that has been shaped to fit the child is inserted through the cuts and placed under the sternum (breastbone).
  • This bar is guided into position using a small video camera called a thoracoscope. This camera is placed inside the chest and removed after surgery.
  • Then the surgeon uses a special instrument to rotate the bar and lift the sternum or breastbone. No bone or cartilage is removed. The bar is left in place for at least 2 years.

The surgery may take 1 to 4 hours.

Alternative Names

Funnel chest repair; Chest deformity repair; Sunken chest repair; Cobbler's chest repair; Nuss repair

Why the Procedure Is Performed

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.

Risks

The risks for any anesthesia are:

The risks for any surgery are:

Risks for this surgery are:

Before the Procedure

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:

  • What drugs your child is taking. Include drugs, herbs, vitamins, or any other supplements you bought without a prescription.
  • About any allergies your child may have to medicine, latex, tape, or skin cleaner

During the days before the surgery:

  • About 10 days before surgery, your child may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), warfarin (Coumadin), and any other drugs that make it hard for blood to clot.
  • Ask your child's doctor which drugs your child should still take on the day of surgery.

On the day of the surgery:

  • Your child will usually be asked not to drink or eat anything after midnight the night before surgery.
  • Give your child any drugs your doctor told you to give with a small sip of water.
  • Your child's doctor or nurse will tell you when to arrive at the hospital.
  • The doctor will make sure your child has no signs of illness before surgery. If your child is ill, the surgery may be delayed.

After the Procedure

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.

Outlook (Prognosis)

Improvements in appearance are usually good. Improvements in breathing or ability to exercise varies from patient to patient.

References

Boas SR. Skeletal diseases influencing pulmonary function. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Medicine. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 411.

Chung D. Pediatric surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 67.

Updated: 1/29/2013

John A. Daller, MD, PhD, Department of Surgery, Crozer-Chester Medical Center, Chester, PA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Stephanie Slon, and Nissi Wang.


©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com