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Steven
Stylianos, MD
Associate Professor of
Clinical Surgery and Pediatrics,
Children's Hospital of
New York What
is Pectus Excavatum?
Pectus excavatum is a depression
of the sternum (breastbone) and the adjacent ribs. The deformity
is referred to as "sunken" or "funnel" chest and the severity
of the depression ranges from mild to severe. Mild cases may
respond to an exercise and posture program, whereas more severe
cases require surgical correction. Pectus excavatum can "run"
in families and is often obvious at birth, often progressing
as the child gets older.
What
are the indications for surgery?
Surgical correction of
pectus excavatum is performed for BOTH medical and cosmetic
(self-image) reasons. Children with moderate to severe defects
often report exercise intolerance manifested by shortness of
breath and chest pain on exertion. The displacement and compression
of the heart and lungs may explain these symptoms.
What
are the advantages of the new "Video-Assisted, Minimal Access"
technique for repair of pectus excavatum (Nuss Procedure)?
In the past, a variety
of radical procedures were advocated. However, a new technique
for correction of pectus excavatum has been developed and refined
by Dr Donald Nuss, a pediatric surgeon at Children’s Hospital
of the King’s Daughters in Norfolk, Virginia. The Nuss Procedure
allows complete repair of the pectus excavatum deformity without
the need for an anterior skin incision, rib resections, or fracture
of the sternum. Blood loss is minimal and recovery time short.
What
preoperative screening and evaluations are needed?
After a complete health
history, thorough physical examination, and measurements, children
whose condition is considered severe enough to warrant surgery
undergo a chest CT scan. The CT scan helps confirm that a child
fulfills established criteria for surgery since not every child
requires surgical correction. Focused cardiology and pulmonary
consultations are obtained for unique signs and symptoms.
What
are the key steps of the operation?
Under general anesthesia,
two small lateral incisions are made on each side of the chest
for insertion of a curved metal bar beneath the sternum. A tiny
video camera is inserted into the chest to monitor proper bar
placement. The bar length and curvature are individually determined
for each child. The bar elevates the sternum and is secured
to the ribs under both incisions. No sutures are visible on
the skin and two band-aids are the only bandages. The bar is
removed as a minor outpatient procedure in two years.
What
are the potential complications?
Complications of this Minimal
Access procedure are uncommon. Air in the chest (pneumothorax)
is the most frequent complication but usually requires no treatment
other than surveillance chest X-rays to document spontaneous
resolution. The bar occasionally requires repositioning. The
use of video technology to ensure optimal bar placement has
added to the safety and effectiveness of the procedure.
What
is the recovery period?
The immediate recovery
time in the hospital is 4-5 days including one day in the Pediatric
Intensive Care Unit for proper pain management. Assistance with
movement (so as not to dislodge the bar) and patient/parent
education are coordinated by Dr Stylianos (pediatric surgeon),
Laura Flanigan, RN (pediatric surgery nurse clinician), and
the staff nurses. After discharge, the patient gradually resumes
normal activities within sensible guidelines. Most children
return to school in 2 weeks with restrictions (ie. no physical
education class, no heavy bookbags). The patients are seen in
the office two weeks and one month after surgery and, if fully
healed, may return to normal activities except contact sports.
For more information contact
Dr. Steven Stylianos by phone (212
305-8861) or email.
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