The Nuss procedure is a minimally invasive technique to repair pectus excavatum. It utilizes small incisions to place one or two metal bars under the sternum or breast bone to raise it flat. Small cameras are used to visualize the inside of the chest to avoid injury to the heart and lungs.
Ideally, we would like to see children right before they start puberty, around 12 to 14 years of age. The bar stays in place for about 3 years. As the child grows and matures, the cartilage and bones begin to mature to keep the chest in the fixed position.
There are many factors that determine the right patient for a Nuss procedure. We measure the chest to evaluate the depth of the pectus excavatum in order to understand the severity of the disease. In addition, patients got through a series of testing to evaluate their lung and hear function. Patients have various combinations of ailments associated with their pectus excavatum. Each patient is evaluated individually to personalize their care and surgery.
There are usually four tests that patient undergo during their evaluation period. These consist of an EKG, echocardiogram, pulmonary function tests, and a CT or MRI of their chest. Depending on the scheduling, these tests may take a few weeks to accomplish.
The Nuss operation changes the chest to a normal shape within hours so there is certainly a level of pain and discomfort following surgery. Children’s Memorial Herman Hospital is aware of the potential long- term effects of opioid use and abuse. As such, the program offers innovative techniques to pain management.
Cryoanalgesia is a specialized technique that provides long term pain relief to patients. During surgery, affected nerves in the chest wall are temporarily frozen, preventing pain signals from transmitting to the brain. Because of this, patients experience less pain after surgery and may experience a shorter recovery time. In addition, patients are often discharged without the need of prescription based pain medication. Nerve function will return to normal 2-3 months after surgery.
For most patients, benefits of cryoanalgesia are seen immediately after surgery. These include:
Mostly adolescents and young adults undergo the Nuss procedure each year. The use of cryoanalgesia significantly reduces the prescription opioid medication use in this population.
The operation typically lasts between two and four hours depending on the severity of the pectus excavatum and the number of bars needed to raise the chest.
Typically, the patients say in the hospital 4 to 5 days.
There are different stages of recovery. The hospital stay is about 4 to 5 days. This is the roughest period where the acute pain is controlled and the patient recover. Usually the lack of appetite after surgery prevents the transition to oral pain medication that keeps patient from being discharged.
There is a two to three period afterwards that is a slower recovery at home. Children have their pain controlled by the medications but need assistance from family to accomplish daily activities. After the period, patients generally are able to return to school but may be dependent on occasional pain medication.
Patients report that it takes around 6 months before they feel completely normal again. They are off their pain medication.
Patients have routine follow-up in the Pediatric Pectus Clinic. Patients are typically seen 1-2 weeks after surgery. If all is well, they are seen at 6 months, 1 year, 2 years, and 3 years. At the third year visit, we plan for taking out the bar.
Yes. Patients go back to any activity one they are feeling well. Heaving lifting and contact sports/activities is reserved to six weeks after surgery. Patient gradually get back to normal activity, but this may take several months.
As with every surgery, patients are at risk of bleeding and infection from surgery. Patients are given antibiotics for infection risk. During the operation, a small camera is used to visualize the bar passing through the chest to avoid injury to blood vessels, lungs, and the heart.
Although the Nuss bar is fixed to the chest wall with sutures and bar stabilizers, the bar can shift or move after surgery. Depending on the severity and timing, bar movement may need to be repositioned.
The Pediatric Pectus Program is the only dedicated multispecialty program to treat children with chest wall deformities or pectus disease. Each patient is evaluated and their care is customized to their needs as a patient and their family. The program was created to help all families and their children with pectus conditions. Although surgery typical occurs when the patients are teenagers, many children are born with pectus excavautm or pectus carinatum. Many patients are seen and evaluated in order to counsel the families on their children’s condition.
If you have any questions, use the online tool below to help us connect with you. To schedule an appointment, please contact our clinic using the information below:
Pediatric General & Thoracic Surgery
6410 Fannin Street, Suite 950
Houston, Texas 77030
Office Hours: 8 a.m. to 5 p.m. (Monday-Friday except major holidays)
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