Pectus Excavatum Repair (Minimally Invasive Technique)

Sunken Chest
Sunken chest (called pectus excavatum) is a malformation in which the ribs and chest wall appear indented or sunken toward the spine. It is the opposite of another condition called pigeon chest (pectus carinatum), in which the chest appears to protrude or stick out. Researchers are not sure what triggers the deformity, but it is thought to be caused by excessive growth of rib cartilage. This causes the cartilage to buckle, pushing the sternum or breastbone inward or outward.

The exact incidence of sunken chest is not known, but researchers believe the abnormality may occur in up to one out of 300 live births. Although the condition may be noticeable at birth, it often becomes even more apparent in the period of rapid growth during puberty. The degree of abnormality can vary from mild to severe. In severe cases, the rib cage can press against the heart and lungs causing chest pain, breathing difficulty, fatigue, and reduced tolerance for exercise.

Treating Sunken Chest
Surgical correction of sunken chest is generally recommended when patients have moderate to severe malformations or experience symptoms related to the condition. In the standard procedure, doctors make an incision across the chest just below the nipples. The overgrown cartilages are removed and the sternum is cracked and repositioned. A short stabilizing bar is placed under the sternum for additional support. The bar stays in place for 6 months. In the six to eight weeks after surgery, new cartilage forms to hold the sternum and ribs in position.

A newer technique for correction of sunken chest is the Nuss procedure, named for the surgeon who introduced it in 1998 .* The Nuss procedure is a minimally invasive surgery. A small incision is made on each side of the rib cage. A curved, custom-shaped, stainless steel rod is guided through the rib cage and beneath the sternum. Once in place the rod is rotated, turning the curved portion against the chest wall, pushing the ribs and sternum out. The procedure works in much the same way as orthodontic braces on the teeth. No cartilage or bone is removed. The rod is secured to the chest wall under the skin with sutures and wire and is left in place for about two years.

The sternal correction and recovery time for the traditional and minimally invasive approaches are similar. However, patients and families often prefer the Nuss procedure to traditional surgery because the operation is shorter, has less blood loss, and uses smaller incisions resulting in less scar. There is a small risk of complications with both procedures such as damage to the heart, displacement of the rod, accumulation of fluid in the chest, development of a pneumothorax (air in the chest), or infection. In a small number of patients the condition eventually recurs.

Please contact the Pediatric Surgeons at the Oakland Medical Center if you would like to learn more about minimally invasive surgery for the repair of pectus excavatum.

* Nuss, D, et al: A 10-year review of a minimally invasive technique for the correction of pectus excavatum. Journal of Pediatric Surgery, 1998, 33(4) 545-552.

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