Description

Corrective Surgery for Pectus Deformities Pectus deformities are congenital abnormalities of the chest wall, primarily including: Pectus Excavatum (“funnel chest”) – sternum is sunken inward Pectus Carinatum (“pigeon chest”) – sternum protrudes outward Surgical correction is considered in moderate to severe cases where cosmetic, respiratory, or cardiac symptoms are present, or when non-surgical options (like bracing for carinatum) fail. 🛠️ Types of Corrective Surgery 1. Nuss Procedure (MIRPE) Best for: Pectus excavatum in younger patients with a flexible chest wall Technique: Minimally invasive; curved metal bar is inserted behind the sternum and flipped to push it outward Bar removal: 2–4 years later Pros: Small incisions, less blood loss, quicker initial recovery Cons: Post-op pain, risk of bar displacement, thoracoscopic injury (rare) 2. Modified Ravitch Procedure Best for: Older patients, asymmetric or rigid deformities (excavatum or carinatum) Technique: Open surgery; abnormal costal cartilage is resected, and the sternum is repositioned; optional support bar may be used Pros: Good for complex or rigid deformities Cons: Larger incision, more invasive, longer recovery 3. Abramson Procedure (for Pectus Carinatum) Sometimes called the “reverse Nuss procedure” Technique: Minimally invasive bar placement anterior to the sternum, compressing the protrusion Used in: Patients with pectus carinatum who fail bracing Bar removal: Usually after 2–3 years 4. Non-Surgical Alternatives (Mainly for Carinatum) Bracing: External compression braces (especially effective in children/teens) Vacuum bell therapy: For mild pectus excavatum; uses suction to gradually elevate the sternum Limitations: Requires compliance, not effective in rigid deformities 🧾 Preoperative Assessment Imaging: Chest CT to calculate Haller Index (≥ 3.25 suggests surgical indication) Pulmonary function tests Cardiac evaluation (ECHO) Psychological evaluation (sometimes necessary for body image concerns) 💊 Postoperative Care Pain control: PCA pump, epidural, oral analgesics Hospital stay: 3–7 days depending on procedure Activity: Avoid heavy lifting and contact sports for several weeks/months Follow-up: Periodic assessments; bar removal if implanted 📊 Outcomes High patient satisfaction Improved physical function and psychosocial well-being Low recurrence rates with proper surgical technique