Division of Pediatric General, Thoracic and Fetal Surgery

A Guide to Your Child's Surgery

Our Surgery Guide will help you and your family prepare for your child's upcoming surgery, outlining what to expect from the first pre-op visit all the way through to her discharge.

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Pectus Excavatum (Nuss Procedure)

What is pectus excavatum?
Before the surgery
About the operation
After the operation
Caring for your child
Follow-up surgery
When to call the doctor

What is pectus excavatum?

Pectus excavatum is a deformity of the chest wall, in which the costal (rib) cartilage grows inward, giving a child's breastbone a sunken appearance. Severe cases can cause shortness of breath, difficulty exercising or chest pain, and require surgery.

Before surgery

Before the surgery, your child's healthcare team will ask you questions about her medical history and take chest measurements and photographs. Your child will also have a physical exam, and she may need tests to check heart and lung function. These tests will help your child's doctors decide if the Nuss procedure is right for her.

About the operation

The Nuss procedure was developed in 1985, and is less invasive than past techniques, which required a large wound across the chest wall, removal of rib cartilage, and a stainless steel bar under the breastbone. With the Nuss procedure, children lose less blood and recover more quickly.

The surgery will be performed in the operating room. Your child will receive general anesthesia, then the anesthesiologist will place an epidural catheter in your child's back after he is asleep. He'll receive pain medication through this catheter during and after the surgery.

The surgeon will make an incision in your child's chest under his arm, then place a long curved clamp through the incision and under the sternum until it reaches the other side. The surgeon will use a tiny scope to watch the clamp go safely across the chest between the heart and the sternum. She'll place a custom-made bar under the sternum between the two incisions, then turn it upward and mold the chest by lifting the sternum.

The surgeon will place pieces of thin surgical tape — called STERI-STRIPS — over the incision and cover them with a bandage. Your child will also have an X-ray while he's still in the operating room, so his doctor can check the placement of the bar and ensure there aren't any air leaks in his chest.

After the operation

When surgery is over, your child will go to the post-anesthesia care unit until she's awake and stable, then to a regular hospital room. She'll receive pain medicine through the epidural and an intravenous (IV) line. Your child will be on bed rest, lying on her back for the rest of the surgery day.

Your child is expected to stay in the hospital for four to five days. She will need a follow-up chest X-ray prior to discharge to evaluate the bar.

The day after surgery, she may get out of bed and walk. She'll slowly return to a regular diet. She will begin taking pain medicine by mouth and will go home with this medicine. She will also receive stool softener or gentile laxatives to help avoid constipation.

Your child may go home when she's able to walk without help, her pain is controlled, she has no fever, and she is eating adequate house diet.

Caring for your child

The surgeon will see your child in clinic three to four weeks after the operation, then several times throughout the two years the bar is in place.

While the bar is in place, your child should wear a MEDICALERT bracelet; talk to your surgeon about this. The bracelet should read:

Surgical steel bar in place under sternum
Medical information: Pectus excavatum
Phone number: 1-800-432-5378
Web site: http://www.medicalert.org

Some parents ask about cardiopulmonary respiration (CPR). If your child needs CPR, the best placement for the paddles would be on the front and back of the chest, instead of both paddles on the front.

Sometimes, parents ask about the metal bar and airport security. Most airports' metal detectors won't sound when your child passes through, unless they have an enhanced security system.

Activity restrictions

Follow-up surgery

Your child will need a second surgery later so that the bar can be removed. During this operation, the surgeon will make an incision in the side of your child's chest and remove the bar through this incision, then close the incision with stitches under the skin. Your child will be discharged from the hospital the same day as this surgery.

When to call the doctor

Please watch for signs of complications after the surgery. Call your surgeon's office (at Children's Hospital, call 215-590-2730) if your child has:

Reviewed by: Surgical Advanced Practice Nurses
Date: November 2008

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