Minimally Invasive Repair of Pectus Excavatum
What is Pectus Excavatum?
Pectus Excavatum is a chest disorder occurring in approximately one out of every 1,000 children.
This congenital deformity is characterized by a concavity of the sternum and is often referred to as “sunken” or “funnel” chest. The inward facing sternum can affect heart and lung function. The heart is often displaced to the left side of the chest and there is compression on the heart and lungs. Patients may experience shortness of breath, chest pain, mitral valve prolapse, palpitations, and/or respiratory disease.
Pectus Excavatum is mildly present at birth and worsens as the child grows. The deformity can magnify considerably during the teenage growth years.
Those suffering from Pectus Excavatum may also experience emotional side effects including negative self-image and low self-esteem.
Post-Operative Guidelines
Implant stability is key to the successful correction of Pectus Excavatum. Following the post-operative instructions below will aid in ensuring maximum stability of the implant.
Restricted Activities
These guidelines are important to avoid irritation, pain, and movement of
the implant. Please consult your surgeon before starting any exercise routine.
Avoid For 1 Month:
- Bending at the waist. (Patient should bend only at the hip).
- Twisting at the waist
- Rolling on to either side
- Running or aerobic activity
- Any other strenuous activity
Avoid For 3 Months:
- Heavy lifting (including school books and backpacks)
- Aerobic activity (avoid up to a minimum of 6 weeks)
Activities
- Practicing good posture to help maintain implant stability
- Walking frequently to aid in building strength after the surgery
- Deep breathing exercises as prescribed by your doctor
- Moderate exercise is encouraged after the first six weeks of recovery
*Before starting any exercise routine, please consult your surgeon or physician
Diet
- Patients may return to a regular diet once home, making necessary adjustments for
- any medications prescribed by their doctor.
The Nuss Technique and Lorenz Pectus Bar
Previously, surgical correction of this deformity was made through an invasive procedure requiring resection of both cartilage and bone. It required hours of operating time and could leave the patient with a more rigid than normal chest. Dr. Donald Nuss, in cooperation with Walter Lorenz Surgical, Inc., developed a minimally invasive surgical procedure and Pectus Bar implant to remodel the chest wall over a 2 to 3 year period.
The Nuss Technique uses principles of minimal-access surgery and thoracoscopy combined with the proper placement of a Lorenz Pectus Bar to achieve correction of pectus Excavatum. The pectus bar is bent specifically for each patient based on the degree of correction required. The curvature of the pectus bar reflects the ideal shape of the patients chest and is inse4rted while the patient is under general anesthesia. The bar is implanted under the sternum. In order to prevent movement of the bar a stabilizer is placed on either side of the patient. The correction of the chest should be visible immediately after surgery although the bar is intended to stay implanted for a minimum of two years.
The bar is not visible from outside of the chest and complications of this surgery are uncommon, however, with any surgery there are risks involved. Please consult your surgeon for the risks or visit our website at www.lorenzsurgical.com for additional information. This method of treatment represents significant advantages over alternative corrective procedures and offers the following benefits to patients:
Minimally Invasive Operation
The Nuss technique will require only three small incisions; one tow-inch incision on each side used for insertion of the bar and one smaller incision on the patient’s right side used for insertion of the thoracoscope.
Reduces Operating Time and Blood Loss
Operating time required for the Nuss Technique is approximately 45 minutes and patient blood loss is generally 10-30 ccs. In comparison, the operating time for a full chest reconstruction is approximately 4 hours and patient blood loss may reach 300ccs.
Minimal Recovery Time
The average recovery time in the hospital is 4-5 days and most children return to school within 2-3 weeks.
Journal Article
Normal Long-Term Chest Correction and Excellent Long-Term Cosmetic Result
A 10-yr study of a Minimally Invasive Technique for the Correction of Pectus Excavatum indicated excellent long-term results. The Journal of Pediatric Surgery, 1998; 33(4). Donald Nuss, M.B., Ch. B, Robert E. Kelly Jr., M.D., Daniel P. Croitoru, M.D. and Michael E. Katz, M.D.
Technique Highlights
Before and after illustration of the minimally invasive repair of pectus excavatum.
CT Scan of a deformity with a Hallard index of 3.5
The patient’s chest is measured to determine what size bar should be used to correct the deformity.
The bar is carefully bent to the shape of the desired form of correction.
The bar fits snugly on both sides of the patient, underneath the patient’s sternum and is worn approximately 2 to 3 years.
Pectus Bar Technique taken from:
- Taken from “The Nuss Procedure” video, Children’s Hospital of the King’s Daughters and Eastern Virginia Medical School, 1998.
- Donald Nuss, M.B., Ch. B., Robert E. Nelly, Jr., M.D., Daniel P. Croitoru, M.D., and Michael E. Katz, M.D., “A 10 Year Study of a Minimally Invasive Technique for the Correction of Pectus Excavatum,” The Journal of Pediatric Surgery, 1998; 33(4).
- Way To Grow Facts: Patient Education ©1997 Pectus Excavatum Surgery CHKD
Contact Information:
John Mark Morales MD, FACS, FAAP
Chief of Cardiothoracic, Director of Perfusion Services
Certified by the American Board of Surgery, American Board of Thoracic SurgeryMark Bielefeld, MD
Driscoll Children's Hospital Chief of Staff
Certified by the American Board of Surgery, American Board of Thoracic SurgeryThoracic surgeons are available for questions and consultations: (361) 854-0201. For appointments, assistance, and physician references in Corpus Christi call: (361) 854-0201 or 800-DCH-LOVE
Fax : 361-855-7572
E-MAIL : jmarkmorales@aol.com
For further information on any surgical procedures you can contact Carol Kaplan, RN, Surgical Nurse Liaison at (361) 694-5150. Consultation and surgery for inpatients is provided in concert with neonatology and pediatric cardiology departments. Complete evaluation and management for infants, children, adolescents and adults with congenital or acquired cardiac, vascular or thoracic anomalies.
Cardiothoracic Associates
3533 S. Alameda, Suite 202
Corpus Christi, Texas 78411
Phone: (361) 694-5150
Fax: (361) 855-7572
Hours: 9am to 6pm
Fri 9am to 5pm
Statement of Compliance
Voted Best Place to Work in 2006 and 2007 | Ways to Give | Contact Us
Copyright © Driscoll Children's Hospital 2008
Corpus Christi, Texas
Live website tracking by Visistat
You
must have Windows Media Player 10 installed on your computer to view the
videos. Click here to download Windows Media Player 10
Click
here to see Alexxandra Contrera's Miracle Story movie
Click
here to learn about International Services
More
information about
