Overview of the Nuss Procedure

Did you know?

Pectus excavatum has been recognized as a disorder as far back as the 16th Century? Learn more about the history of pectus excavatum.

Prior to the advent of the Nuss Procedure, a variety of radical procedures were advocated. These procedures were difficult on the patient, requiring lengthy hospital stays and prolonged recuperaton. This changed in 1987 when Dr. Donald Nuss, a pediatric surgeon at Children's Hospital of The King's Daughters in Norfolk, Virginia, developed a new technique for the correction of pectus excavatum.

The "minimally invasive" procedure, now known as the Nuss Procedure, has been performed on over 1,200 patients and refined and perfected over the years. For patients, this translates into minimal blood loss and significantly shorter recovery time.

Surgical correction of pectus excavatum is done for medical reasons. Children with moderate to severe defects often experience shortness of breath, exercise intolerance and chest pain. These are the results of compression and displacement of the heart and secondary lung compression.

Pre-operative Screening and Evaluations

After a complete health history, a thorough physical exam, chest measurements, and photographs, children whose condition is considered severe enough to warrant surgery are sent for further evaluation of their cardiac status, pulmonary function, and a CT scan. Please visit Patient Evaluation Guidelines for more detailed information.

The Operation

The operation for correction starts with general anesthesia and the placement of an intravenous catheter for the management of pain after the operation. Two lateral incisions are made on either side of the chest for insertion of a curved steel bar under the sternum. A separate, small lateral incision is made to allow for a thoracoscope (small camera) for direct visualization as the bar is passed under the sternum. It is then fixed to the ribs on either side and the incisions are closed and dressed. The bar is not visible from the outside and stays in place for a minimum of two years. When it is time, the bar is removed as an outpatient procedure.

Pre-operative Post-operative

The following documents provide more information about the procedure.

Complications

Complications of this minimally invasive surgery are uncommon. Air in the chest (pneumothorax) is the most frequent complication but usually requires no treatment other than observation and aggressive deep breathing therapy to help promote faster resolution. Bar displacement may occasionally require repositioning, and as with all surgeries, the potential for infection is closely monitored and presently the infection rate is less than 1%.

Recovery

The immediate recovery time in the hospital is 4-5 days. Attention is paid to postoperative pain management, encouragement to breathe deeply, assistance with movement (so as not to dislodge the bar), and patient/parent education. After discharge, the patient is expected to slowly resume normal, but restricted, activity. Most children are able to return to school in two to three weeks, with exercise restrictions for six weeks (i.e. no physical education, no heavy lifting, etc.). Once fully recovered they may return to regular activity. For more information relating to recovery physicial activity, please read the discharge instructions for pectus excavatum correction.

Bar Removal

The pectus support bar is removed between two to four years after insertion on an outpatient basis. The procedure is done under general anesthesia and in over 160 patients who have had their bars removed there were no complications. Patients were able to leave the hospital within one to two hours after bar removal. Patients who reside more than one hour from the hospital are expected to spend their first night in town. Learn more about the Bar Removal Procedure.

Long-term Results

Long-term follow-up (over 15 years) shows the Nuss Procedure provides excellent results with less than 5% recurrence of the deformity after the bar is removed.