What is Pectus Excavatum?
Pectus excavatum is a depression of the sternum (breastbone) and the adjacent ribs. The deformity is referred to as "sunken" or "funnel" chest and the severity of the depression ranges from mild to severe. Mild cases may respond to an exercise and posture program, whereas more severe cases require surgical correction. Pectus excavatum can "run" in families and is often obvious at birth, often progressing as the child gets older.

What are the indications for surgery?
Surgical correction of pectus excavatum is performed for BOTH medical and cosmetic (self-image) reasons. Children with moderate to severe defects often report exercise intolerance manifested by shortness of breath and chest pain on exertion. The displacement and compression of the heart and lungs may explain these symptoms.

What are the advantages of the new "Video-Assisted, Minimally Invasive" technique for repair of pectus excavatum (Nuss Procedure)?
In the past, a variety of radical procedures were advocated. However, a new technique for correction of pectus excavatum has been developed and refined by Dr Donald Nuss, a pediatric surgeon at Children's Hospital of the King's Daughters in Norfolk, Virginia. The Nuss Procedure allows complete repair of the pectus excavatum deformity without the need for an anterior skin incision, rib resections, or fracture of the sternum. Blood loss is minimal and recovery time short.

What preoperative screening and evaluations are needed?
After a complete health history, thorough physical examination, and measurements, children whose condition is considered severe enough to warrant surgery undergo a chest CT scan. The CT scan helps confirm that a child fulfills established criteria for surgery since not every child requires surgical correction. Focused cardiology and pulmonary consultations are obtained for unique signs and symptoms.

What are the key steps of the operation?
Under general anesthesia, two small lateral incisions are made on each side of the chest for insertion of a curved metal bar beneath the sternum. A tiny video camera is inserted into the chest to monitor proper bar placement. The bar length and curvature are individually determined for each child. The bar elevates the sternum and is secured to the ribs under both incisions. No sutures are visible on the skin and two band-aids are the only bandages. The bar is removed as a minor outpatient procedure in two years.

What are the potential complications?
Complications of this minimally invasive procedure are uncommon. Air in the chest (pneumothorax) is the most frequent complication but usually requires no treatment other than surveillance chest X-rays to document spontaneous resolution. The bar occasionally requires repositioning. The use of video technology to ensure optimal bar placement has added to the safety and effectiveness of the procedure.

What is the recovery period?
The immediate recovery time in the hospital is 4-5 days including one day in the Pediatric Intensive Care Unit for proper pain management. Assistance with movement (so as not to dislodge the bar) and patient/parent education are coordinated by the Pediatric Surgical Team. After discharge, the patient gradually resumes normal activities within sensible guidelines. Most children return to school in 2 weeks with restrictions (ie. no physical education class, no heavy bookbags). The patients are seen in the office two weeks and one month after surgery and, if fully healed, may return to normal activities except contact sports.