Other names: funnel chest or sunken chest.

Indications:

Description of the operation:The repair of pectus excavatum has changed over the past several years. We now use the minimally invasive Nuss procedure. The old procedure required a large incision on the front of the chest and removal of 6-8 sets of cartilage.

The much less invasive Nuss procedure is described here: While the child is deep asleep and pain-free (using general anesthesia), 2 small incisions are made over the sides of the chest and a curved titanium bar is passed behind the breastbone (sternum). The deformed sternum is elevated when the curved bar is turned over. The placement of the bar may be aided by the use of a small scope placed into the chest to monitor the bars progress. Once the bar is in place it is sutured under the muscle so it will not move. Rarely a chest tube may be placed to reexpand the lung if the lining of the lung is entered.

Expectations after surgery:The child will have some pain after the procedure but this will be controlled with either an epidural catheter or a PCA (patient controlled analgesia) pump. The child is usually in the hospital 3 to 4 days after the surgery. The metal bar is removed 2-3 years later through a small skin incision. This removal is usually done as an outpatient. After the repair the child will be on restricted activity for a time period and will gradually return to full activity.