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Pectus Excavatum Surgery Procedure - The Nuss Surgery Detailed Explanation

Updated on January 4, 2010
This hub will a continuation from my last hub which was an introduction into pectus excavatum surgery this hub will go into the detail of the actual surgery procedure including graphic images.
This hub will a continuation from my last hub which was an introduction into pectus excavatum surgery this hub will go into the detail of the actual surgery procedure including graphic images.

Warning Graphic Images

1. The first step will be a course of antibiotics at the time of surgery to prevent infection and reduce the development of pneumonia. This surgery is performed under general anesthesia with a muscle relaxant and epidural block for both operation and pain control purposes.

2. The patient is then positioned with both arms extended out sideways to allow better access to chest wall. Padding under the arms will prevent any neurologic injury.

3. The patient is then draped, and the chest is marked and sterilized. The deepest section of the pectus is marked. If the deepest point of the pectus is inferiro to the sternum, then mark the lower end of the sternum. Using this point, establish a horizontal plane across the pectus area. Extend the horizontal plane to the lateral chest wall and mark between the anterior and midaxillary lines for transverse lateral incisions.

4. The preop chest measurements are then double chcked. And the proper bar is then selected for beind into the desired chest wall curvature. A bar will be chosen specifically for your chest that will give you maximum stability and correction.

5. Using the pectus bender, the bar is shaped from the center outward making small gradual bends. It may be necessary to exaggerate the curvature slightly to allow for chest wall pressure downward force on the sternum. Avoid bending the lateral ends of the bar.

6. 2.5cm incisions are then made at the marks previously made. A skin tunnel is raised from both incisions to the top of the pectus ridge at previously selected space. The pectus bar then enters the chest slightly elevated from the pectus ridge. 

7. A thoracoscope is used during the procedure to get an idea of where all the surrounding organs are in order not to damage them. The pectus bar is then entered from the patients right side with the proper pectus introducer in order to make a tunnel for the implant. Small introducers are used for patients 4 to 12 years old and the longer one for patients 13 - 20 or older.

8. The introducer is slowly eased in through the side of chest and pushed through to the other side of the chest. From here the surgeons can begin elevating the sternum. 

deliberately made it small incase it scares some of you
deliberately made it small incase it scares some of you

 9. The sternum is then lifted into place from both sides. Pressure is applied above and below the sternum to obtain the desired curvature of the sternum. This process may be repeated a few times in order to stretch the connective tissue and correct the deformity prior to inserting the main bar. Two strangs of umbilical tape are then tied through each end of the hole this will be later used to guide the bar through the hole. 

The bar is then inserted and flipped into a position that will push the sternum outwards to the desired position. 

Surgeon holding a pectus stabilizer, ooh don't drop it just kidding
Surgeon holding a pectus stabilizer, ooh don't drop it just kidding

10. At this point the stability of the bar is checked. Depending on how stable the bar is it will dicatate if any stabilization need take place. Patients typically require one bar to achieve correction but some may have 2 or 3 for more severe deformities.

A stabalizer bar is then fitted to each end of the pectus bar. Patients 4 to 13 years have one stabilizer per bar , and 14 to 18 years of age have one or two depending on patients muscular development and activity level (sports , gym e,g)

 

11. The bar and stabilizer are then secured to each other and to the chest wall and the bar and stabilizer are covered up. The incisions are then closed up and a chest radiograph is obtained postop to check for pneumothorax and is an excellent way to see final bar placement.

thanks for reading, hope it helped you understand the procedure more if you need more information I can add it but my next hub shall be about postoperative care and things you need to do after your operation to maintain the benefits from the surgery.

More information on the Pectus Excavatum Surgery can be found at pesurgery.com , a friend started the site to help people decide if the surgery is for them or even if the surgeons will perform the surgery on you.

- Pectus Excavatum Surgery – The Nuss Procedure Benefits

Pectus Excavatum Plastic Surgery – Pectus Excavatum Insert


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    • profile image

      Shane 

      6 years ago

      I always get made fun of because i have it to, but who cares!!!

    • profile image

      Daniel 

      6 years ago

      Is there a possibility that you could die in the surgery??

    • expectus profile imageAUTHOR

      expectus 

      7 years ago from Land Downunder

      Douglas - depending on the type of cover you have, talk to your insurance provider or government health ware provider and find out how much they are willing to pay

      NIKOS - if you experience pain, you can try improving your posture and if you still feel discomfort it may be worth getting a scan

    • profile image

      NIKOS 

      7 years ago

      i get that too every once in a while should i be worried?is PE something to worry about (i don't have big breathing problems) ?

    • profile image

      Douglas 

      7 years ago

      i have Pe too and im 19 what are the symptoms of compulsory surgery because i get chest(heart) pain now and then..its awfully expensive and i don't have the cash for it.so how would i go about getting it done and getting it paid by my medical insurance

    • expectus profile imageAUTHOR

      expectus 

      8 years ago from Land Downunder

      its hard to say if it affect your growth but generally there should be no change in your natural growth

    • profile image

      Alex hampson 

      8 years ago

      im 15 years old and im wondering if having the surgery will afect my growth in any way or will it help to improve it?

    • expectus profile imageAUTHOR

      expectus 

      8 years ago from Land Downunder

      jon - the doctor will give you a whole heap of maintenance exercises to do after the surgery and if you don't do them , It will probably return to its former state , the only difficult step for you is finding a doctor to perform the operation on you as many doctors/surgeon's don't perform the surgery on adults, but some will it depends where you are , health condition, condition of your PE etc...

    • profile image

      jon 

      8 years ago

      Can this surgery be performed on 39yr old? I never had the option as a child but want to get it fixed. Also, what are the chances your chest will go back in after the bar is removed in 2-3 yrs?

      Thanks for all,

    • profile image

      BSA345 

      8 years ago

      BEING AN FORMER PATIENT OF DR. DONALD NUSS. IT ALL DEPENDS IF YOUR INSURANCE COVERS IT. MOST LIKLEY IT WILL BUT THE COST IS ABOVE $15,000 BECAUSE OF THE SEVERITY OF THE SURGERY AND IT IS CONSIDERED A LIFE-THREATENING SURGERY BECAUSE OF THE EFFECT IT COULD HAVE ON YOUR LIFE. THE RECOVERY TIME IS 4 TO 6 WEEKS BUT IT ALL DEPENDS ON HOW YOUR BODY HANDLES THE HEALING.

    • profile image

      Droid 

      8 years ago

      The recovery is 6 weeks.

    • profile image

      Stu 

      8 years ago

      What is the cost of the procedure and how long is the recovery?

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