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Pectus Deformity and Correction – FAQs

Posted by: admin on September 8th, 2012

What is a chest wall deformity?

Chest wall deformities are abnormally shaped chest/thorax due to abnormal development of the ribs, cartilage or breast bone. Common types of chest wall deformities are pectus excavatum, pectus carinatum and their combination known as excavatum-carinatum complex.

 

What is pectus excavatum, pectus carinatum and excavatum-carinatum complex?

Pectus excavatum or funnel chest is when the breast bone is depressed so chest appears sunken or hollow   and pectus carinatum or pigeon chest wherein   the breast bone is raised so the chest appears protruded, complex is a combination of both.

 

How common is it?

The funnel chest defect is the more common type and it affects males more often than females occurring in about 1 in 500 to 1000 births.

 

What causes these chest wall deformities?

These are congenital defects where the exact cause is unknown, family history is present in 40 % of cases.

 

What kind of problems does pectus carinatum cause?

Patients get tired sooner than their peers as the defect prevents proper functioning of heart and lungs. It also has psychosocial impact on patient’s self-image and confidence

 

What problems does pectus excavatum cause?

Depending on severity of deformity the heart and the lungs get compressed decreasing their functions.

1. Exercise intolerance and shortness of breath: The parents notice their child cannot keep up with other children in physical activity.

2. Chest pain which may be independent of exercise.

3. Psychosocial effect: Poor body image, decreased self confidence and altered behavior: They avoid activities that involve removing their shirt, such as swimming.

 

What tests are required for a pectus evaluation?

Physical exam is required on every patient followed by chest x-ray and chest CT scan. They assess the severity of the deformity and degree of compression of the heart and lungs. An echocardiogram to evaluate heart function and pulmonary function tests to evaluate lung function is also done.

 

What is the age for treatment?

The younger the better, when the bones are soft and remodel easily with less pain. The ideal scene is a preschool child repaired at 3 years of age and bar removed at 5 years before starting school. Adults beyond 40s have also been repaired.

 

What are the treatment options for pectus excavatum?

For pectus excavatum, surgical repair can be accomplished in one of two ways.

 

Open technique:

The classic open Ravitch technique involves a big incision for repair of the deformity. It involves removal of the abnormal bones and cartilage and regrowth of the bones and cartilage. This causes a weak chest till the time of bone healing which can takes from months to years.

 

Minimally Invasive Repair / NUSS procedure:

The present day technique involves inserting a stainless steel bar through small incisions about 2cm on either side of the chest under video guidance. This is referred to as the minimally invasive pectus repair. The bar is then secured after lifting the chest wall defects into normal position. The bones then remodels into normal shaped chest. As no bones are removed there is no chest wall weakness.

 

What are the treatment options for pectus recurvatum?

For pectus recurvatum, surgical repair can be accomplished using.

 

Reverse Nuss procedure

It involves inserting stainless steel bar through small incisions of 2cm on either side of the chest under video guidance. The bar is then secured after depressing the chest wall protrusion into normal position. The bones then remodels into normal shaped chest. As no bones are removed there is no chest wall weakness.

 

Sandwich technique

It involves inserting stainless steel bar through small incisions of 2cm on either side of the chest under video guidance. The bars then sandwich the deformity on either side allowing the bones to remodel into normal shaped chest. As no bones are removed there is no chest wall weakness.

 

What are the treatment options for pectus excavatum-carinatum complex?

Surgical repair can be done using

 

Sandwich technique / Press mold technique

It involves inserting stainless steel bar through small incisions of 2cm on either side of the chest under video guidance. The bars then sandwich or press mold the deformity on either side allowing the bones to remodel into normal shaped chest. As no bones are removed there is no chest wall weakness.

 

How long will my child be in the hospital after repair?

The average stay for a person who undergoes the minimally invasive pectus repair is approximately seven to ten days. By the time they are discharged from hospital they will be eating, walking, and comfortable. They will need to take some pills for the pain; which is stopped gradually in few days.

 

When will the bars be removed from the chest?

The bars will be inside the chest for about 2 years in children, 3 to 4 years in teenagers and adults. At the end of this period they are removed.

 

What to expect after surgical correction?

Benefits are three folds;

  1. Physiology of heart and lung function improves.
  2. Psychosocial – Improved self confidence.
  3. Cosmetic – Symmetrical chest shape and no big scar of incision

 

Minimally Invasive Repair of Pectus Excavatum

Posted by: admin on May 4th, 2012

Dr. L.M.Darlong specializes in a modified form of minimally invasive repair of pectus excavatum [MIRPE] using advanced Nuss procedure. It is a modified Nuss procedure with repair using thoracoscopy, pectoscopy and crane lift. He also specializes in Pectus recurvatum and Pectus excavatum-recurvatum complex repair using Reverse Nuss, Sandwich technique and press mold technique.

 

Benefits over conventional (open surgery), MIRPE and Parks technique.

 

Thoracoscopic assisted MIRPE Pectoscopy MIRPE

Thoracoscopy vision restricted to the green area of heart

Pectoscope showing a continous view beyond midline

Heart injuries caused by the tip of the instruments with Thoracoscopy

Pectoscope view beyond midline
Approaches 100 % safety in safe hands

 

Open surgery/Ravitch NUSS Procedure / MIRPE Pectoscopy MIRPE
Based on regeneration of bones and cartilage Based on bone remodeling over stainless steel bar Based on bone remodeling over stainless steel bar
Involves removal of bones and cartilage, associated injury to muscle and rib cage No bones and cartilage removed No bones and cartilage removed
Big incision over entire breast bone 3 incisions used, about 1inch on either side of chest for bar insertion and one additional incision for thoracoscopy. 2 small incision about 1 inch on either side of chest. A pectoscope passed through this incision.
More blood loss Blood loss minimal Blood loss minimal
Unstable chest wall after bone and cartilage removal Stable chest wall Stable chest wall
Large wound -Wound infection risk higher Small wound- Less risk Small wound- Less risk
Bigger scar No visible scar No visible scar
Large skin incisionExtensive excision of bones, cartilage and muscle in Ravitch procedure Space not created behind breast bone Crane technique – Breast bone lifted and space created- Safety
Risk of injury to heart Minimize heart injury by crane technique- Safety
Thoracoscope – Vision restricted till the midline of chest Pectoscope- Vision throughout the chest from left to right or right to left – Safety
Blind procedure beyond midline – Risk of injuring the heart Procedure done under vision throughout – Minimal risk of heart injury- Safety
Not morphology specific Morphology tailored repair –TERCOM technique
Conventional Bar fixators Specially designed Bar fixators and Hinge support
Restricted activity – as chest wall stabilization requires minimum 6 month. Normal activity in about 6 weeks time Normal activity in about 6 weeks time

 

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