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Pectus Excavatum Surgery Recovery Time

Treatment Options For Pectus Excavatum

Recovery From Pectus Excavatum Repair

Pectus excavatum typically becomes more noticeable during puberty when your child begins to grow rapidly.

Adolescents with a severe case of pectus excavatum and associated symptoms may be a candidate for surgical repair during the teenage years with the minimally invasive repair of pectus excavatum .

Vacuum Bell Therapy offers a nonsurgical treatment option for pectus excavatum. VBT uses a suction device to gradually lift the sternum/chest wall. Correction using VBT typically does not improve the appearance of the chest as much as surgical correction. However, for some children, VBT represents a potential alternative to surgery.

What Is The Nuss Procedure

The Nuss procedure is a minimally invasive procedure for surgical correction of pectus excavatum. Childrens Hospital surgeons have performed more than 500 Nuss procedures, and typically perform approximately 40 cases each year. The procedure is typically performed from age 10 up until the age of 19.

The Nuss procedure involves a concave stainless steel bar that is slipped under the sternum with the assistance of a scope using two small incisions on each side of the chest. The bar is then flipped, and the sternum moves to the proper position.

To support the bar and keep it in place, a metal plate called a stabilizer is inserted on both sides of the chest. The stabilizer fits around the bar and into the ribcage where it is secured in place.

The stainless steel bar does have tiny nickel and chromium components therefore, if your child has a nickel or chromium allergy, a titanium bar will be used. Take note of your childs reaction to wearing earrings or belts. Getting a rash from a belt buckle or swollen ears from stainless steel earrings can be indicative of a nickel allergy. Let your surgeon know if you have observed the signs of a nickel allergy. Before surgery, all patients will have patch testing to determine whether or not they have a true nickel allergy and require a titanium bar.

The Modified Ravitch Procedure

This procedure requires elevation of the sternum and surrounding area, removal of abnormal cartilages, and fixation of the sternum in a more natural position with a metal bar.

This metal bar stays in your chest for at least a year. After this reshaping period, it is removed with another procedure. While this procedure has a good history of correcting the condition, it requires a cut on the front of the chest.

The modified Ravitch operation includes creating a horizontal cut from one side of the chest to the other. Drains are injected on each side of the chest to remove any fluid from the operation. The injury is closed using dissolvable stitches.

A strut is injected to settle the chest in place permanently but may be removed if it causes pain or other problems. This operation might take several hours and requires postoperative hospitalization for pain control.

Physical activity is seriously restricted for several months as the coastal cartilages slowly grow back together.

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What Will Pectus Excavatum Surgery Cost Will My Insurance Cover It

The cost of this surgery will depend on the technique used for your surgery, what complications you may develop, and other health factors unique to you. If your surgeon indicates that your surgery is medically necessary, it is likely to be covered by your insurance, but check with your individual plan before scheduling surgery. Different health plans may assign you different shares of the surgical cost.

What You Need To Know About This Procedure

Dr. Joel Cazares MD FACS, Pectus Surgeon in Monterrey, , Mexico

The Ravitch procedure is used to correct a severe case of pectus excavatum.

Its usually used for patients from 13 to 22 years old.

  • A cut is made across the chest.
  • The bone cartilage is reshaped.
  • Bars are placed to keep the sternum in its new position.
  • Bars are removed in about 612 months.
  • One or more drains are placed under the skin to drain fluid from the surgery site.
  • A chest tube may be placed to prevent the lung from collapsing.
  • The cut is closed.

A few months after the surgery, the cartilage grows and keeps the chest in a new position.

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What Is The Cause Of Pectus Excavatum

The cause of pectus excavatum is not known however it can run in families, with up to 25 percent of affected patients reporting chest wall abnormalities in other family members. Pectus excavatum occurs in approximately 1 out of 4001000 children and is three to five times more common in males than females. This may be an isolated abnormality or may be found with other malformations including scoliosis, kyphosis, and connective tissue disorders such as Marfan syndrome. The deformity usually becomes more severe as the child grows.

Some children with pectus excavatum report that they have chest pain and shortness of breath or limited stamina with exercise. Other children have no symptoms. Surgery may not alleviate chest pain.

Moving The Body Properly

It is crucial for patients with pectus deformities to remain still and only move minimally during the first few days postsurgically.

Lifting, moving, or stretching may interfere with the injurys healing process. Forcing the body can occasionally pull the incision apart, causing the healing process to delay.

Again, following your surgeons post-surgery instructions about moving and breathing techniques is critical.

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History Of The Ravitch Procedure

At the beginning of the 20th century, there has been significant progress in anesthesia. That led to the development of breast surgery.

Among the first operative procedures for fixing pectus excavatum was the removal of deformed rib cartilage, especially the second and third ribs on the right.

Meyer did this type of surgery in 1911. However, this procedure did not result in clinical improvement in the deformity.

Two years later, in 1913, Sauerbruch, a pioneer of thoracic surgery, articular negative pressure cabin for chest surgeries with a more aggressive strategy in treating pectus excavatum.

As a result of his hard work, for the first time in the treatment of pectus excavatum deformity, there was significant clinical improvement in patients.

The operative procedure involved cutting out a portion of the chests anterior wall, including rib cartilages from the fifth to ninth ribs on the left and part of the sternum.

Postoperatively, cardiac pulsations were evident because the bone defect was covered only with a set of muscles.

The patient with severe dyspnea and pulsations earlier in the surgery can continue to live generally without any clinical problems typically.

He thought the deformity was caused by a severe mechanical backward pull of the anterior wall of the chest by the short diaphragmatic ligaments.

Guided by these views, he invented two surgical procedures to treat pectus excavatum. The first procedure was performed on young children.

His method involved:

Do I See The Surgeon Again After The Operation

Pectus Excavatum Surgery: What Should I Expect After Surgery?

If all is going well, we recommend a visit to our office between two and four weeks after hospital discharge. A visit with your child’s pediatrician one to two weeks after the discharge is also a good idea. You should call our office if you are worried about how things are going once your child is home.

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Ravitch Procedure Risks / Fails / Death Rates

The most common complications of this surgical method are:

  • Displacement of bars.

Early complications of Ravitch surgery are usually classified as:

  • Antitoxin in the wound.
  • Infection of the wound.
  • Development of pleural effusion.

Patients with pneumothorax need control to normalize pulmonary function. Hypertrophic scars inside areas of the anterior chest wall are also considered to be postoperative complications.

However, proper surgical technique and good postoperative scar treatment reduce the chances of this complication. Most failed surgeries are caused by mispositioned or displaced bars.

Bars that were too long or placed too laterally are the most common problems. The risks for recurrence are also often related to incomplete healing and difficulties:

  • Incomplete removal of involved cartilages.
  • Operation is too extensive.

Support Bar Removal & Recovery

The metal struts that support your chest are removed one year after they are inserted. A pre-surgical visit is needed. The removal surgery takes about one hour.

The pectus bars are removed two years after insertion with minimally invasive surgeries like the Nuss procedure. It is also an outpatient process that takes about one hour. A visit to the doctors office is required just before removal.

Following the Ravitch procedure, you will be hospitalized for 3-5 days. The therapeutic team will work with the surgical team to ensure that pain is well controlled so that you can recover smoothly.

Multiple ways can control your pain. A team of doctors will come up with a plan based on your recovery. Initially, doctors will use pain medications to manage your pain. When you begin to eat, oral pain medications will be used.

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What Is A Nuss Procedure

A Nuss procedure is a minimally invasive surgical repair to fix pectus excavatum. People who have this sunken chest issue are candidates for the Nuss procedure instead of an open repair with a larger incision. The procedure uses a titanium bar or bars to push a childs sunken breastbone out. Bars stay in your chest for three years.

Outcomes In Adult Pectus Excavatum Patients Undergoing Nuss Repair

Current Management of Pectus Excavatum: A Review and Update of Therapy ...

Accepted for publication 9 November 2017

30 January 2018Volume 2018:9 Pages 6590

MennatAllah M Ewais, Shivani Chaparala, Rebecca Uhl, Dawn E Jaroszewski

Department of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA

Abstract: Pectus excavatum is one of the most common congenital chest wall deformities. Depending on the severity, presentation of PEx may range from minor cosmetic issues to disabling cardiopulmonary symptoms. The effect of PEx on adult patients has not been extensively studied. Symptoms may not occur until the patient ages, and they may worsen over the years. More recent publications have implied that PEx may have significant cardiopulmonary implications and repair is of medical benefit. Adults presenting for PEx repair can undergo a successful repair with a minimally invasive Nuss approach. Resolution of symptoms, improved quality of life, and satisfying results are reported.

Keywords: complications, minimally invasive surgery, quality of life


Cardiopulmonary outcomes

Figure 1 Computerized tomographic scan of a patient with severe pectus excavatum and Haller index of 24.6. Sternal deformity with compression of the right heart and inflow are seen .

Quality of life and patient satisfaction

Surgical approaches and outcomes

Figure 4 The Rultract retractor can be utilized to forcefully elevate the sternum when attached by a bone clamp.



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Who Is A Candidate For The Nuss Procedure

Not every child with pectus excavatum requires surgical correction. The surgical correction is performed for medical reasons, such as shortness of breath, exercise intolerance, and chest pain. After a complete health history, a thorough physical exam, and chest measurements and photographs, children whose condition is considered severe enough for surgery will be sent for further evaluation of cardiac status, metabolic exercise stress test, pulmonary function, and an MRI scan. This helps determine whether the patient fulfills the criteria for surgery.

The Nuss procedure is usually easier, and the recovery time is often faster, in children with severe pectus excavatum who are preadolescent due to the flexibility of the bones and cartilage. However, there has been an increase in the number of teenagers and adults undergoing the procedure, with equally positive results in many cases.

Testing For Pectus Excavatum In Children

Pectus excavatum can be identified in some toddlers but typically isnt fully diagnosed until children are 10 to 13 years old. This is because cartilage grows as childrens bodies develop, and the appearance of a sunken chest does not guarantee its a chest wall disorder. A physical exam helps your childs provider make a diagnosis. We also conduct follow-up tests to determine the full extent of your childs condition.

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Ravitch Surgical Procedure Step

Operational treatment of chest deformities is done primarily because of medical reasons.

Repairing the deformity will help you with the following:

  • Cardiac and pneumonic functioning recovery

Surgical treatment is rarely used in children under eight years old.

It is essential to use the time between your appointment for surgery and the procedure itself to improve your overall fitness level.

If you smoke, you need to stop. Smoking is terrible for your heart and lungs and may cause risks of developing chest infections during your operation. This would mean that your stay in the hospital could be much more extended than usual.

Evaluation Of Surgical Outcome

Intercostal Cryoablation is Improving Pectus Excavatum Recovery

Chest X-ray showed no sternum depression the morphology of chest wall is symmetry, without depression the patient and their families are satisfied the thorax appears full with good extension and elasticity. The outcome is considered excellent if 4 criteria apply, good for 3, fair for 2 and poor for less than 1.

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Recovery: What To Expect In The Next Few Weeks

  • Most patients feel better after a week at home however, caution must be taken when advancing movement, etc. Activities will be restricted for several weeks to ensure that the bar is secure in place.
  • You may return to light activity, work, or school in two to three weeks and resume some exercise/sports in six to eight weeks. Your pediatric surgeon will advise which activities are safe and when you can participate in sports again. Alternative Names: Sunken chest

Are There Common Problems Or Complications Associated With This Procedure

The most common problems and complications related to surgery have evolved since the operation was first reported in 1998. In the initial series of several hundred patients, it was found that the most common complications were related to bar displacement, pneumothorax, and infection. However, as the technique has improved, the complication rate has dramatically decreased. For instance, bar displacement – which was reported in almost 10% of the patents – is now reported in about 2%. Other problems such as Infection and pneumothorax are very rare. The use of thoracoscopy has also helped in making this a much safer operation. Other very rare complications include the risk of injury to major vessels and the heart now reported to be less than one in a million cases.

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Frequently Asked Questions About The Modified Ravitch Procedure For Treatment Of Pectus Excavatum Or Carinatum

Described in 1949 by Dr Mark Ravitch, it is an open operation with larger cuts or incisions usually made on the front of the chest to correct both types of pectus deformity. It involves a breaking and re-setting of the chest through cutting and removing the cartilage connection between the ribs and the sternum and then cutting the breastbone or sternum to then either lift up the sternum if the operation is being performed for pectus excavatum or push down on the sternum if the operation is being performed for a pectus carinatum.

Like many operations, over the years the original procedure has been modified. The Modifications from the original Ravitch procedure include leaving some of the skin of the cartilage behind so that the cartilage would partially re-grow into its new alignment many mini cuts of the sternum with or without fixing the sternum into its new shape , and lifting the sternum using internal supports to hold the sternum forward in pectus excavatum. If surgery being performed for pectus carinatum no metal bars are typically used, though recently using some form metal fixation to hold or internally fixed the sternum backwards has been used. At present, most patients undergo a modified version of this procedure.

During: Meticulous attention to surgical technique and using local anaesthetic nerve blocks will help reduce the pain after the operation.

Complications associated with this type of surgery include:

What Happens During The Nuss Procedure

Pectus Excavatum Surgery Introduction

The Nuss procedure has several steps. The surgeon:

  • Makes two small cuts in the side of the chest.
  • Places one or more steel bars behind the breastbone and attaches them to the outer edge of the ribs. They use a tiny camera to get the bars in the right place.
  • Turns the bars, raising the breastbone.
  • Places a metal plate , sutures , or wire to hold the bars in place.
  • The chest reshapes after about 24 years. Then the surgeon removes the bars.

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    What Happens During Pectus Excavatum Surgery

    Before surgery, will have received specific instructions on when to stop eating, and what medications you should or should not take in the days prior. You may have additional testing done on the day of surgery.

    When your surgeon is ready to begin the operation, you will be taken to the surgical area and placed under general anesthesia. This is a medication that allows you to sleep and slows your body systems during the operation. During general anesthesia, you can expect to have a breathing tube placed to help you breathe. You will not be awake and will not feel pain during surgery.

    To begin surgery, you will be placed on an operating table and the area will be scrubbed and cleaned with antiseptics. Your upper torso will be covered with sterile drapes to prevent infection and surgical incisions will be made based on the specific technique your surgeon has chosen.

    Tips To Heal A Scar After Surgery

    In most circumstances, the size of a scar and its healing process determine many factors, including the size of the incision, how quickly it heals, the skin type, the patients age and health, and how well the patient cared for it.

    The faster and easier a scar heals, the less noticeable it is.

    Before you leave the hospital, doctors will give you a manual on taking care of yourself and what you can and should not do, all to heal faster and recover.

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