The Nuss Procedure for Pectus Excavatum Correction

Abstract

Pectus excavatum is an anterior chest wall deformity that now can be corrected with a minimally invasive technique known as the Nuss procedure. Patient criteria and assessment for this new surgical procedure are defined clearly in advance to ensure the need for surgical intervention. A multidisciplinary team approach has been established at Children's Hospital of The King's Daughters, Norfolk, Va. Team members work cooperatively throughout the perioperative cycle, addressing not only the surgical procedure but also pain management and postoperative recovery. This dedicated team approach helps ensure a successful outcome for the patient.

Is epidural anesthesia truly the best pain management strategy after minimally invasive pectus excavatum repair?

“…approach all patients undergoing a pectus deformity repair with an attempt at epidural placement under the assumption that this provides the most effective strategy for pain control [3][4][5][6][7][8]12]. We conducted a retrospective evaluation to examine the validity of this assumption and to investigate whether there is a role for a prospective study to determine the optimum postoperative management of these patients.…”

Surgical Treatment for Pectus Excavatum

“…It was seen more frequently in boys than in girls with a ratio of 4:1. About 90% of patients are diagnosed before one year of age, but the exact cause is not known (2). The possible theories of pectus excavatum were reported as increased intrauterine pressure, rickets, abnormality of the diaphragm that result in posterior traction on the sternum (3,4).…”

Pectus Excavatum

“…Postsurgical results after the Nuss procedure. Overall, complications of surgical correction are rare, with the most frequent being pneumothorax, shifting of the sternal bar in the Nuss procedure and infection (Fonkalsrud & Bustorff-Silva, 1999;Fonkalsrud, Beanes, et al, 2002;Swoveland, Medvick, Kirsh, Thompson, & Nuss, 2001;Wu et al, 2001). Overall, complications of surgical correction are rare, with the most frequent being pneumothorax, shifting of the sternal bar in the Nuss procedure and infection (Fonkalsrud & Bustorff-Silva, 1999;Fonkalsrud, Beanes, et al, 2002;Swoveland, Medvick, Kirsh, Thompson, & Nuss, 2001;Wu et al, 2001).…”

“…These patients cannot be log rolled and can only assume the supine position when in bed to prevent unintentional dislodgement of the sternal bar (Swoveland et al, 2001). These patients cannot be log rolled and can only assume the supine position when in bed to prevent unintentional dislodgement of the sternal bar (Swoveland et al, 2001).…”