Pectus excavatum repair - Overview
Funnel chest repair; Chest deformity repair; Sunken chest repair; Cobbler's chest repair; Nuss repair
Definition of 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 - 4 hours.
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.
- Reviewed last on: 1/24/2011
- Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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.
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