Reducing Recovery Times - The Nuss Procedure

The Nuss procedure was developed as a minimally invasive treatment for the most common chest deformity known as pectus excavatum. Pectus excavatum, or funnel chest, is a disorder in which the center of the chest is depressed or sunken. It occurs more frequently in boys than girls-about 0.2% of white male children are affected with pectus excavatum.

The Nuss procedure has only been widely used since the late 1990s and was developed as an alternative to more aggressive surgical treatments for pectus excavatum. Older surgical approaches to the chest deformity, like the Ravitch repair, were associated with very long recovery times. Nuss procedure recovery, while still challenging, is far less demanding for the patient than recovery from other repair techniques. Dr. Daniel Nuss developed the self-named named Nuss procedure to reduce recovery times and improve outcomes.

The Nuss procedure essentially involves the placement of a curved bar or rod across the chest. Thus instead of the chest cage being curved inward towards the body, the chest curves slightly away from the body, more like normal. The deepest part of the chest concavity is measured and the highest points are used to determine where the incisions in the chest will be made. Once measured, two deep incisions are made on the right and left sides of the chest so that a bar can be inserted and advanced across the vertical center of the deformity.

In order to advance the bar in the Nuss surgery, a tunnel must be formed across the chest. The tunnel is made under the pectoral muscles. When the bar is first inserted in the Nuss procedure, it is placed so that the curve of the bar is facing towards the body. Once the bar is passed through the chest tunnel, it is turned over so that the convexity or curve is facing out or away from the body. Turning the bar pulls the chest muscles up and increases the effective diameter of the chest.

Interestingly, the bar that is placed during a Nuss procedure is not a permanent fixture, at least when the Nuss surgery is performed during childhood. The bar stays in place for about two to four years-until the chest has grown into its adult, more normal shape. After Nuss procedure recovery and subsequent chest growth, the bar can be removed in an outpatient procedure. In children less than 10 years old, the bar can be removed two years after the Nuss surgery. In children over 13 years of age, the bar may need to stay in place for up to four years. In adults, the bar will stay in place for at least four years in most cases until further determination about the chest anatomy can be made.

Even though the Nuss procedure has only been a published surgical technique for about 10 years, it has become a patient and surgeon favorite for treatment of pectus excavatum. There is a steep learning curve for surgeons and the procedure is not without complications. About 10% of the time the bar will slip or move, which requires correction (perhaps surgical). About 5% of the time, the lung may collapse though this is treated with a temporary chest tube. In general, Nuss procedure recovery and possible complications are fairly minimal when compared other surgical approaches.