Minimally Invasive Surgery |
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Pectus Excavatum Repair
What is pectus excavatum?
Pectus excavatum is the most common chest wall deformity in children, occurring more frequently in boys than in girls. It results from abnormal growth of the cartilage - the soft, flexible tissue attached to the sternum or breastbone -- causing the chest wall to curve inward. Pectus excavatum often is apparent at birth but typically becomes more severe over time.
Why does my child need surgery?
In most children, this deformity poses no health risk and surgical repair is done primarily for cosmetic reasons.
How is the operation performed and how long does it take?
Repair of pectus excavatum can be accomplished in one of two ways. The traditional approach involves a long incision across the chest to remove the deformed cartilage. The sternum is then moved forward and secured in the corrected position with metal struts. This operation takes about four hours to complete.
Another approach involves inserting a stainless steel "pectus" bar through a band-aid-size incision on each side of the chest. The pectus bar is inserted through one of the side incisions and placed under the sternum, moving it forward. The bar is then secured to the chest wall. This operation is completed in about one hour.
In both operations, all stitches are placed under the skin. These stitches dissolve so no stitches are removed after the operation. Your child's incision will be covered with small bandages.
How long will my child stay in the hospital?
The pectus repair is a painful procedure. The length of stay in the hospital for your child will depend on the level of pain after the operation. Most children stay in the hospital for about five days after the operation. An epidural catheter, which is placed in the back, is used to give continuous pain medication. This is used for several days, when the pain is the greatest. While the epidural is in place, your child will have a catheter in the bladder to drain urine and may be given oxygen with a small tube under the nose.
After a few days, pain medication is given orally and the epidural is removed. In some children, it may be necessary to place a small tube or tubes in the incision to drain fluid. These are removed when the drainage stops, usually after several days. You can help speed your childs recovery by encouraging activities such as deep breathing, walking and sitting in a chair, as soon as possible after the operation.
How do I take care of my child at home after leaving the hospital?
Here are some tips for caring for your child:
- Pain — When your child leaves the hospital, you will be given a prescription for pain medication to you to take to your local pharmacy.
- Activity — To avoid dislodging the pectus bar, we recommend no contact sports for at least a month following surgery. Except for that restriction, your child can go about his or her activities as usual.
- Bathing — Your child may bathe or shower after the epidural catheter is removed. When your child is home, he or she may bathe or shower without restriction.
- Dressings — Gauze and clear plastic dressings, placed over the incisions, may be removed a few days after surgery. Over the incision, there will be small, white strips of adhesive tape on which there may be a small amount of blood. This is normal. The skin surrounding the incision may be red and bruised and the incision may be slightly swollen. Your child can bathe with the tape in place. Eventually, the tape will loosen and fall off.
- Swelling — There may be some swelling at the site of the incision. After the incision heals, you will feel a firm ridge, called a "healing ride," under the incision. This is where the tissues are sewn together. It may be present for several months.
Will my child see the surgeon after the operation?
If all goes well, we recommend a visit to our office between two
and four weeks after your child leaves the hospital. We
also recommend a visit with your childs pediatrician one
to two weeks after discharge from the hospital. Please call
our office at (415) 476-2538 if you have any concerns once
you child is home.
When do I call your office?
Call our office at (415) 476-2538 if you have any concerns or
if you child develops:
- A temperature of 101.5 F or higher
- A red incision
- Worsening pain and tenderness at the incision
- Fluid emerging from the incision
When are the metal struts or pectus bar removed?
With an open or traditional repair, the metal struts are removed a year after insertion. A pre-surgical visit is required. Removal takes about an hour and is performed as an outpatient procedure so you can return home with your child the same day.
With minimally invasive repair, the pectus bar or bars are removed two years after insertion as an outpatient operation that takes about an hour. Please arrange a visit to our office one year after the struts or bar is inserted and then again at two years, just prior to removal.
Glossary
Cartilage — Soft flexible tissue attached to bone.
Sternum — The bone in the middle of the chest, attached to the ribs.
Incision — The surgical cut into the skin.
Metal struts — Small metal bars that fix the cartilage and sternum in a flat position.
Pectus bar — A stainless steel bar placed over the ribs and under the sternum that moves the sternum forward in a flat position.
More Information:
Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.
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