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Minimally Invasive Surgery

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Pectus Excavatum (Sunken Chest)

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Some babies are born with a condition called pectus excavatum or sunken chest. This condition is caused by ribs and the sternum not growing properly, resulting in a deformity in the chest. The chest has a concave or sunken appearance. Children with pectus excavatum can often have chest pain and discomfort, breathing difficulties, especially during exercise and sunken chest can cause chest pain, shortness of breath and fatigue. This is caused by the suppression of the chest wall and pressure put on the heart and lungs.

Thanks to the advent of minimally invasive surgery and advanced techniques, WakeMed offers a procedure called the Nuss Procedure that can correct this condition and allow for normal chest development in children. This surgery is recommended for children over age 6 since children are generally mature enough at this age to follow post-operative instructions. In some cases, the deformity may necessitate surgery at an earlier age.

Nuss Procedure
The Nuss Procedure, named after the pediatric surgeon who perfected the surgery in the late 1980s, provides effective correction for children who are born with sunken chest. Instead of a complicated open surgery, the Nuss Procedure offers a faster recovery, shorter hospitalization and less pain.

First, the child is given general anesthesia and receives an intravenous catheter to control pain after surgery. The pediatric surgeon makes two small incisions on either side of the chest so that a curved steel bar can be inserted under the sternum. Another tiny cut is made to insert a thoracoscope (small camera) into the chest. This instrument gives a clear field to visualize placement of the bar. Once the bar is in place, the surgeon affixes it to the ribs on either side and closes the incisions. Over time, the bar becomes secured with muscle tissue that regrows around it. The bar will remain in place to help support chest development for about two years and will be removed during an outpatient procedure.

Children typically are hospitalized for four to five days so that they can be monitored to ensure the bar is stabilized and breathing is normal. Both patient and parents undergo training and education to understand how to manage movement during the critical first few weeks of recovery. Patients slowly resume normal activities, but sports and other contact-related activities are restricted for about six to eight weeks following surgery.

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