Surgical Treatment for Pectus Excavatum
- Surgical Treatment
The ideal age for surgical treatment of pectus excavatum is between 12 and 18 years. The goal of surgery to correct a pectus excavatum defect is to improve the patient's breathing, posture and cardiac function, in addition to giving the chest a normal appearance. This is typically accomplished by repositioning the breastbone. Surgical repair has excellent success rates, with cardiovascular and lung function return to near normal in the majority of patients. Our surgeons are able to treat most pectus excavatum patients — both adolescents and adults — using minimally invasive techniques.
Recovery after pectus excavatum repair varies depending on the patient's age and the amount of chest depression. Most patients leave the hospital within 3 to 5 days and can return to school or work within two to three weeks. Patients must avoid vigorous exercise for the first month after surgery, and contact sports for three months after surgery.
The minimally invasive Nuss procedure is performed with general anesthesia. Performed using video-assisted thoracoscopic surgery or VATS, the Nuss procedure creates a horizontal passage underneath the sternum through two small incisions in the side of the patient's chest. A separate, small incision enables the surgeon to view the inside of the chest with the thoracoscopic camera. A convex bar known as the Lorenz pectus bar is specially shaped to fit the patient's anatomy, inserted through the passage, and then turned to push the sternum outward. The bar must remain in place for a minimum of two years while the chest heals and re-forms to its new shape. The bar is removed as an outpatient procedure.
Many adults have undergone minimally invasive pectus repair with the Nuss procedure, which was originally developed for the repair of pectus excavatum in children. The results appear to be as good as with the modified Ravitch procedure (description follows below), which has been the traditional approach to repairing pectus excavatum in adults.
Modified Ravitch Repair
The procedure is performed with the patient under general anesthesia.
Utilizing a horizontal incision, the modified Ravitch technique involves removing small pieces of deformed chest cartilage and repositioning the protruding ribs and sternum. To support the repaired chest architecture, titanium bars are secured to the ribs and sternum.
Previously, the supports used to keep the sternum in place needed to be removed after several years. The bars currently used are secured to the chest wall in such a fashion that they can remain permanently in place, thereby avoiding the need for a second operation.