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At UPMC Children's Hospital of Pittsburgh, we believe parents and guardians can contribute to the success of this surgery and invite you to participate. Please read the following information to learn about the surgery and how you can help.
Pectus (PEK-tuss) is a Latin word that means “chest,” and excavatum (ek-ska-VAT-um), also Latin, means “caved in.”
The ribs are attached to the bone in the middle of the chest called the sternum (or breastbone) with cartilage (KART-il-ij). Cartilage is soft, flexible tissue. Pectus excavatum, also called “funnel chest,” is a condition that occurs when this cartilage overgrows onto itself, causing the sternum to curve inward, making the child’s chest look as if it has been “pushed in.”
When this condition occurs, the heart is pushed from the “midline,” or center of the chest, and rotated to the left side of the chest, possibly affecting its ability to pump blood. When the heart can’t pump blood the way it should, the child may get tired quickly during exercise. The curve of the sternum also may cause a squeezing effect on the lungs, making it harder to breathe.
The surgery is elective, meaning it can be done when parents want to schedule it. Many choose to have their child’s surgery during the summer to allow their child more time to heal without missing school.
The surgery is done under general anesthesia (an-es-THEEZ-ya). General anesthesia makes your child’s whole body go to sleep and is needed for this surgery so that his or her reflexes will be completely relaxed. General anesthesia makes the surgery easier and safer to do because your child will not feel any pain or have any memory of the surgery.
Before your child is admitted to the hospital for surgery, he or she is required to have the following outpatient tests:
When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, you will receive a phone call from a nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions.
For children older than 12 months:
For infants under 12 months:
For all children:
The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.
A pediatric anesthesiologist—a doctor who specializes in anesthesia for children—will give the medications that will make your child sleep during the surgery.
Before the surgery, a member of the anesthesia staff will meet with you to take your child’s vital signs, weight and medical history. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.
The anesthesiologist will meet with you and your child to review your child’s medical information and decide which kind of sleep medication your child should get.
While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously.
Once questions are answered and the operating room is prepared, your child will be taken into the operating room and given an anesthetic to make him or her go to sleep. When your child is asleep, the surgery will begin.
Surgeons have two ways of doing a pectus excavatum repair surgery:
The “Nuss” procedure, named after Dr. Donald Nuss, uses a thorascope, or small camera, to see inside the chest cavity while the surgeon does the repair. This technique avoids a large incision (cut) and the removal of the cartilage. Instead, the surgery is done through small incisions. A “pectus” bar is inserted into the chest to support the sternum. The bar is made of titanium and comes in various lengths. Your surgeon will select a length based on your child’s chest size. The bar is about 11/2 inches wide. It also can be bent during the surgery, using special instruments. This is the most common method used to repair pectus excavatum at Children’s.
The second, and less common method for pectus excavatum repair, is the traditional “open” procedure, in which the surgeon makes a large incision to give a full view of the areas involved in the repair surgery. The open procedure is done mostly on older teenagers when the breastbone is less mobile.
When your child is moved to the recovery room, you will be called so that you can be there as he or she wakes up. While your child is in recovery, your surgeon will talk to you about the surgery. That is a good time to ask questions about pain medications, diet and activity.
The Nuss procedure is painful for the first few days after the surgery. Your child will have an epidural (ep-i-DOOR-ul) catheter while in the hospital. The epidural catheter will be inserted during surgery to allow the continuous flow of pain medication for a few days after surgery. Your child will continue to be on a mild pain medication by mouth for about 2 weeks after the surgery.
Following an open procedure, your child will be given a strong pain medication prescribed by your surgeon. It will be necessary to take the medication for about 5 to 7 days after surgery. Your child also might have an epidural catheter for a few days after surgery.
If your child had the open procedure, small tubes will be inserted into the incision to drain fluid. A chest tube is almost always needed after the open procedure to remove air from the chest cavity. It is also used in the open procedure to remove blood from the chest cavity. The chest tube is used until there is no more air or blood to come out – usually for about 2 to 4 days.
If your child had the Nuss procedure, these tubes will most likely not be necessary, but there is a possibility that they will be used in certain conditions.
Before leaving the hospital, you will be given a prescription for your child’s pain medication and instructions for taking the medication. Your child may resume most normal activities.
Your child will be scheduled to see the surgeon between 2 to 4 weeks after leaving the hospital.
Parents and guardians may call the office any time they have questions or concerns. You should call right away if:
If you have any specific questions about your child’s surgery, you should discuss them with the surgeon before the surgery. You may call the Division of Pediatric Surgery at Children’s and ask to speak with your child’s surgeon, or speak with him or her during the pre-surgical examination on the day of the surgery.
If your child has any special needs or health issues you feel the doctor needs to know about, please call the Division of Pediatric Surgery at Children’s before the surgery and ask to speak with a nurse. It is important to notify us in advance about any special needs your child might have.
Division of Pediatric Surgery
UPMC Children's Hospital of Pittsburgh
One Children’s Hospital Drive
4401 Penn Ave.
Pittsburgh, PA 15224
Children's Hospital's main campus is located in the Lawrenceville neighborhood. Our main hospital address is:
UPMC Children’s Hospital of Pittsburgh
One Children’s Hospital Way
4401 Penn Ave.
Pittsburgh, PA 15224
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