Pectus excavatum repair is surgery to correct pectus excavatum, a deformity of the front of the chest wall with a sunken breastbone (sternum) and ribs.

There are two types of surgery to treat this condition -- open and closed. In the more traditional, open approach, the surgeon makes a surgical cut over the front part of the chest. The doctor removes the deformed cartilage and leaves the rib lining in place to allow the cartilage to regrow correctly.

An incision is made in the sternum and it is repositioned. A rib or metal strut may be used to stabilize the sternum in normal position until healing occurs in 3 - 6 months. A temporary chest tube may be placed to re-expand the lung if the lining of the lung is entered. This procedure is done while the child is deeply asleep and pain-free (using general anesthesia).

Metal struts are removed 6 months later through a small cut in the skin under the arm. This procedure is usually done on an outpatient basis. Most repairs are done when the child is 18 months - 5 years old. However, there has been debate about the best age for the procedure.

The second type of surgery is the "Nuss procedure." It is a closed, less-invasive approach. A curved steel bar is placed beneath the breastbone (sternum) through two small cuts made under the arms. This bar is guided into position using a small video camera (thorasoscope) placed inside the chest.

Then a special instrument helps rotate the bar and raise the deformed sternum. No bone or cartilage is removed. The bar is left in place for at least 2 years. This technique, although newer, has shown excellent long-term (10-year) results when it is performed at specialized surgical centers.

Pectus excavatum repair may be recommended for:

• Improved appearance (cosmetic repair)
• Improved breathing (the patient may not have noticed a gradual restriction in breathing)
• Improved exercise capacity
• Improved posture
• To prevent restrictive lung disease or reduced exercise capacity as an adult, or late in life

The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

• Bleeding
• Infection
• Scarring

• Lung collapse
• Recurrence of the deformity

Cosmetic results are generally good. The success of the procedure to improve breathing or exercise capacity varies from patient to patient. Many affected children have other connective tissue disorders, and will need surgery to treat them.

Hospitalization for 1 week is common. Vigorous activity may need to be restricted for 3 months.

Tzelepis GE, McCool FD. The Lungs and Chest Wall Disease. In: Mason RJ, Murray JF, Broaddus VC, Nadel JA. Murray & Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa; 2005:chap 83.

Sugarbaker DJ, Lukanich JM. Chest Wall and Pleura. In: Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Townsend: Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 57.