Pectus excavatum repair
Funnel chest repair; Chest deformity repair; Sunken chest repair; Cobbler's chest repair; Nuss repair; Ravitch repairPectus excavatum repair is surgery to correct pectus excavatum. This is a congenital (present at birth) deformity of the front of the chest wall that causes a sunken breastbone (sternum) and ribs.
Pectus excavatum
Pectus excavatum is a medical term that describes an abnormal formation of the rib cage that gives the chest a caved-in or sunken appearance....
Read Article Now Book Mark ArticlePectus excavatum is also called funnel or sunken chest. It may worsen during the teen years.
Description
There are two types of surgery to repair this condition -- open surgery and closed (minimally invasive) surgery. Either surgery is done while the child is in a deep sleep and pain-free from general anesthesia.
General anesthesia
General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive the...
Read Article Now Book Mark ArticleOpen surgery is more traditional. The surgery is done the following way:
- The surgeon makes a cut (incision) across the front part of the chest.
- The deformed cartilage is removed and the rib lining is left in place. This will allow the cartilage to grow back correctly.
- A cut is then made in the breastbone, which is moved to the correct location. The surgeon may use a metal strut (support piece) to hold the breastbone in this normal position until it heals. Healing takes 3 to 12 months.
- The surgeon may place a tube to drain fluids that build up in the area of repair.
- At the end of surgery, the incision is closed.
- The metal struts are removed in 6 to 12 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 method. It is used mostly for children. No cartilage or bone is removed. The surgery is done the following way:
- The surgeon makes two small incisions, one on each side of the chest.
- A small video camera called a thoracoscope is placed through one of the incisions. This allows the surgeon to view inside the chest.
- A curved steel bar that has been shaped to fit the child is inserted through the incisions and placed under the breastbone. The purpose of the bar is to lift the breastbone. The bar is left in place for at least 2 years. This helps the breastbone grow properly.
- At the end of surgery, the scope is removed and the incisions closed.
Surgery may take 1 to 4 hours, depending on the procedure.
Why the Procedure Is Performed
The most common reason for pectus excavatum repair is to improve the appearance of the chest wall.
Sometimes the deformity is so severe that it causes chest pain and affects breathing, largely in adults.
Surgery is mostly done on children who are 12 to 16 years old, but not before age 6. It can also be done on adults in their early 20s.
Risks
Risks for anesthesia and surgery in general are:
- Reactions to medicines
- Breathing problems
Breathing problems
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
Read Article Now Book Mark Article - Bleeding, blood clots, or infection
Bleeding
Bleeding is the loss of blood. Bleeding may be:Inside the body (internal)Outside the body (external)Bleeding may occur:Inside the body when blood le...
Read Article Now Book Mark Article
Risks for this surgery are:
- Injury to the heart
- Lung collapse
Lung collapse
A collapsed lung occurs when air escapes from the lung. The air then fills the space outside of the lung between the lung and chest wall. This buil...
Read Article Now Book Mark Article - Pain
- Return of the deformity
Before the Procedure
A complete medical exam and medical tests are needed before the surgery. The surgeon will order the following:
- An electrocardiogram (ECG) and possibly an echocardiogram that shows how the heart is functioning
Electrocardiogram
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
Read Article Now Book Mark ArticleEchocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
Read Article Now Book Mark Article - Pulmonary function tests to check for breathing problems
Pulmonary function tests
Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning.
Read Article Now Book Mark Article - CT scan or MRI of the chest
CT scan
A chest CT (computed tomography) scan is an imaging method that uses x-rays to create cross-sectional pictures of the chest and upper abdomen....
Read Article Now Book Mark ArticleMRI
A chest MRI (magnetic resonance imaging) scan is an imaging test that uses powerful magnetic fields and radio waves to create pictures of the chest (...
Read Article Now Book Mark Article
Tell the surgeon or nurse about:
- Medicines your child is taking. Include drugs, herbs, vitamins, or any other supplements you bought without a prescription.
- Allergies your child may have to medicine, latex, tape, or skin cleanser.
During the days before the surgery:
- About 7 days before surgery, your child may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), warfarin (Coumadin), and any other blood thinning drugs.
- Ask your surgeon or nurse which drugs your child should still take on the day of surgery.
On the day of surgery:
- Your child will likely be asked not to drink or eat anything after midnight the night before surgery.
- Give your child any drugs the surgeon told you to give with a small sip of water.
- Arrive at the hospital on time.
- The surgeon will make sure your child has no signs of illness before surgery. If your child is ill, the surgery may be postponed.
After the Procedure
It is common for children to stay in the hospital for 3 to 7 days. How long your child stays depends on how well the recovery is going.
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 collects from the procedure. The tubes will remain in place until they stop draining, usually after a few days. The tubes are then removed.
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, they are probably ready to go home. Before leaving the hospital, you will receive a prescription for pain medicine for your child.
At home, follow any instructions for caring for your child.
Instructions
You or your child had surgery to correct pectus excavatum. This is an abnormal formation of the rib cage that gives the chest a caved-in or sunken a...
Read Article Now Book Mark ArticleOutlook (Prognosis)
The surgery usually leads to improvements in appearance, breathing, and ability to exercise.
References
Kelly RE, Martinez-Ferro M. Chest wall deformities. In: Holcomb GW, Murphy JP, St. Peter SD, eds. Holcomb and Ashcraft's Pediatric Surgery. 7th ed. Philadelphia, PA: Elsevier; 2020:chap 20.
Wald O, Izhar U, Sugarbaker DJ. Lung, chest wall, pleura and mediastinum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 58.
Pectus excavatum - illustration
Pectus excavatum is a condition in which the breast bone (sternum) appears sunken and the chest concave. It is sometimes called funnel chest. The majority of these cases are not associated with any other condition (isolated findings). However, some genetic conditions include pectus excavatum.
Pectus excavatum
illustration
Pectus excavatum repair - series
Presentation
Pectus excavatum - illustration
Pectus excavatum is a condition in which the breast bone (sternum) appears sunken and the chest concave. It is sometimes called funnel chest. The majority of these cases are not associated with any other condition (isolated findings). However, some genetic conditions include pectus excavatum.
Pectus excavatum
illustration
Pectus excavatum repair - series
Presentation
Review Date: 1/23/2023
Reviewed By: Mary C. Mancini, MD, PhD, Cardiothoracic Surgeon, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.