Nuss procedure for pectus excavatum

Introduction

•The Nuss Procedure, a minimally invasive approach to correcting pectus excavatum, involves surgeons inserting a curved metal bar under the ribs and sternum to reshape the chest wall and may improve the cardiopulmonary function.

•On average, the bar remains in place for 2-4 years, at which point it is surgically removed. The inpatient stay for most patients is between four and seven days.

Post-Op Care

Once the surgery is completed, your child will be taken to the recovery room or Post-Anesthesia Care Unit (PACU) for observation. The length of time spent in the PACU will depend upon their response to the surgery and anesthesia. Typically, children who have undergone the Nuss Procedure are moved to a regular room within a few hours.

Pain Management

•To manage any pain your child might experience, the healthcare professionals will use a Pain Controlled Analgesia (PCA) pump. The pump allows you or your child to push a button, which releases a small dose of pain medication (based on your child's weight). The machine is programmed to allow a specific dose and the timer on the machine controls how often the medication can be dispensed, even if you or your child pushes the button more frequently.

•Pain medications may cause side effects such as nausea, vomiting, itching, constipation or sedation/excessive sleepiness. Your child's doctors will order medications to manage these side effects.

Hospital Stay

•You can expect your child to be in the hospital for four to five days. During that time, we will closely monitor and control their pain, have them do deep-breathing exercises, assist with movement and provide instructions on recovery.

•For the 3 days after the operation, your child will need to remain still to minimize the risk of bar displacement. After that time, they can begin to sit up and begin walking with the help of a physical therapist.

•Deep-breathing exercises and walking are very important to help your child breathe easier as they recover. Once your child is able to get up and walk around with little assistance and no longer requires an IV for pain management, he or she is ready for discharge.

Homecare After Nuss Procedure

• Your child should be up and walking as he or she is able. It is common to hear an occasional popping sound as the ribs slide along the bar. — If there is a loud popping sound and it is very painful, call your child’s surgeon right away. Your child may need to have an x-ray.

• Increase activity slowly. Take your child for a walk every day and walk a little longer distance or a little faster every day.

• The following restrictions are in place for the first 4 weeks after surgery:

No log-rolling

No side-lying or laying on one’s stomach

No bending/twisting/straining/heavy lifting or reaching high over head

No contact sports or physical education

No carrying a backpack at school

• No contact sports or lifting greater than 10 pounds for 3 months. Your child can run, throw a ball, and do other physical activities once the surgeon says it is okay. This is usually around 6 weeks after surgery.

Follow-up care

• Call the surgeon’s office today for a follow-up appointment for 2 to 3 weeks after your child’s surgery. The surgeon needs to see how your child is doing after the surgery.

When to call the surgeon

• If your child is having trouble breathing or you are concerned with your child’s health, take your child to the nearest emergency room.

• Call the surgeon’s office if your child’s pain is not under control or the pain gets worse.

• Call the surgeon’s office if your child has any of these in the first few weeks after surgery:

— fast heart beat

— throws up often

— loose stools often

— is not pooping every 1 to 2 days

— does not want to eat (loss of appetite)

— incision is red, swollen, or leaks fluid

— incision is more painful

— is hard to wake up

— temperature over 38º C

When are the metal struts/pectus bar removed?

With the minimally invasive repair, the pectus bar(s) is (are) removed two to four years after insertion. A visit to our office is required at one year and again at 2 years, just prior to removal.

Reference

https://surgery.ucsf.edu/conditions--procedures/nuss-procedure.aspx