Pectus excavatum repair

Definition

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.

Alternative Names

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

Description

There are 2 types of surgery to repair this condition -- open surgery and closed 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 an incision (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. It is used mostly for children. No cartilage or bone is removed.

• The surgeon makes two small incisions, one under each arm. A curved steel bar that has been shaped to fit the child is inserted through the incisions 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.

Risks

The risks for any anesthesia are:

• Reactions to medicines
• Breathing problems

The risks for any surgery are:

• Bleeding
• Infection
• Scarring

Risks for this surgery are:

• Lung collapse
• Return of the deformity