Pectus Repair
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Pectus Excavatum  Lyall A. Gorenstein, MD |
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At Columbia, a full range of treatment options is available to patients and their families, who have access to multiple Columbia specialists through the course of consultation and treatment. These include pulmonologists, pediatricians, surgeons, radiologists, a pediatric psychosocial team, and rehabilitation specialists.
Our goal is to provide complete clinical resources for the patient and family for diagnosis and decisionmaking about treatment, and if surgical treatment is chosen, for recovery, rehabilitation, and return to school or work, and exercise. While we treat most patients with the minimally invasive Nuss procedure, some patients are better treated with physical therapy or other surgical procedures.
Read about pectus excavatum.
Surgical Treatment
Thoracic surgeon Lyall Gorenstein, MD, collaborates with Dr. Charles A. Stolar, Pediatric Surgeon-in-Chief and other specialists at Columbia University Medical Center in the care of patients with pectus excavatum, consulting with the family regarding the patients surgery, recovery, rehabilitation, return to school, and athletic exercise.
The ideal age for surgical treatment of pectus excavatum is between 12-18 years of age. The goal of surgery to correct a pectus excavatum defect is to improve the patient's breathing, posture and cardiac function, in addition to giving the chest a normal appearance. This is typically accomplished by repositioning the breastbone. Surgical repair has excellent success rates, with cardiovascular and lung function return to near normal in the majority of patients. Columbia surgeons are able to treat most pectus excavatum patients—both adolescents and adults—using minimally invasive techniques.
Many school age patients undergo surgery during the summer months to avoid missing time in school. Adults undergoing surgery often coordinate the procedure with their work schedule to minimize time off.
Nuss Procedure
The minimally invasive Nuss procedure is performed with general anesthesia, as well as placement of an epidural catheter for pain management after the operation. Performed using video-assisted thoracoscopic surgery or VATS, The Nuss procedure involves creation of a horizontal passage underneath the sternum through two small incisions in the side of the patient's chest. A separate, small incision enables the surgeon to view the inside of the chest with the thoracoscopic camera. A convex steel bar known as the Lorenz pectus bar is specially shaped to fit the patient's anatomy, inserted through the passage, and then turned to push the sternum outward. A metal plate and sutures secure the bar and prevent it from moving ("wandering") while the chest tissue re-forms. The bar must remain in place for a minimum of two years while the chest heals and re-forms to its new shape. The bar is removed as an outpatient procedure.
Many adults have undergone minimally invasive pectus repair with the Nuss procedure, which was originally developed for the repair of pectus excavatum in children. The results appear to be as good as with the modified Ravitch procedure (description follows below), which has been the traditional approach to repairing pectus excavatum in adults. Columbia University Medical Center has long been known for its expertise in repairing pectus deformities in children and adults, and our thoracic surgeons are able to to select those adults best suited for minimally invasive pectus repair, and use the conventional modified Ravitch procedure when appropriate.
Modified Ravitch Repair
The procedure is performed with the patient under general anesthesia. An epidural catheter is placed for pain management after the operation.
Utilizing a horizontal incision, the modified Ravitch technique involves removing small pieces of deformed chest cartilage and repositioning the protruding ribs and sternum. To support the repaired chest architecture, titanium bars are secured to the ribs and sternum.
Previously, the supports used to keep the sternum in place needed to be removed after several years. The bars currently used are secured to the chest wall in such a fashion that they can remain permanently in place, thereby avoiding the need for a second operation.
Recovery
Recovery after pectus excavatum repair varies depending on the patient's age and the amount of chest depression. Most patients leave the hospital within 3 to 5days and can return to school or work within two to three weeks. Patients must avoid vigorous exercise for the first month after surgery, and contact sports for three months after surgery.
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