Surgery for Pectus Excavatum
Pectus can be corrected through surgery in a variety of ways.
The most common of these is the minimally invasive procedure, often referred to as the Nuss Procedure.
During this procedure the chest is elevated, lifting the sternum off of the heart, and two or more metal bars are inserted underneath the ribcage. These bars are left in for a recommended period of three years. Like braces reshape the mouth, these bars reshape the chest.
Dr. J's 4 Unique Techniques
1
Forced Sternal Elevation
Dr. J lifts the sternum away from the heart by using a bone clamp and a bedside retractor, in order to ensure the bars will cross the chest wall safely and minimize possible trauma to the chest muscles and organs during the procedure. This makes the procedure safer.
2
Shorter, Multiple bars
Dr. J uses shorter bar lengths that curve gently around the front of the chest and are crafted specifically to best correct each patient. The use of shorter bars will help with bending and twisting side to side. Multiple bars are chosen to distribute the pressure of the chest wall on the bars, which can lessen pain, and give a better overall contour and cosmetic result. Dr. J uses multiple bars in all surgeries.
3
FiberWire and Stablizers
Dr. J uses FiberWire, a high-weight, braided plastic suture to secure the bars to the ribs. She weaves the FiberWire around multiple points to reduce the chance of bar displacement. She will only use a stabilizer when necessary and it will be placed close to the middle of the bar, not at the end.
4
Pain Management Techniques
Dr. J uses a poly-pharmacy approach to pain management. This means she uses medications like ibuprofen, Tylenol, and gabapentin to try to minimize the need for narcotics. Dr. J uses cryo-ablation to freeze the nerves and provide post-operative pain relief. For those who do not want cryo-ablation, Dr J will use an On-Q pain pump, by inserting a thin tube underneath the skin to deliver a numbing medication.
Pectus Surgery With Dr. Jaroszewski
The Day Before Surgery:
The day before surgery you will receive a schedule of required preop testing and an appointment with the pectus team for last-minute questions. You will also receive the check-in time for your surgery.
The Day of Surgery:
The morning of surgery you will check into Mayo Clinic at the registration desk on the first floor. You will then be directed to the second floor to be prepped for surgery. This includes placement of an IV line, meeting with anesthesia, and a quick visit from Dr. J. During the surgery, your family is encouraged to stay on Mayo Clinic's campus. When possible, they will be updated during the procedure. After the surgery is complete, Dr. J will meet with your family and discuss the operation. Immediately after surgery, you will be recovering in the PACU (Post-Anesthesia Care Unit). Once stable you will be transferred to a private room, where your family can come and visit you.
Recovering From
Pectus Surgery With Dr. Jaroszewski
The Day of Surgery:
You will receive oral medications when you wake up from surgery. You are encouraged to sit up and practice deep breathing exercises. You may even begin walking the day you've had your operation.
The Day After Surgery:
There will be a continued emphasis on coughing and deep breathing. You will have a chest x-ray in the morning. You should be out of bed, chest tube removed, and should be discharged later that day.
Recovering in Phoenix
The pectus team will see you approximately one week after your surgery for a follow-up exam. They will remove the stitch from the chest tube, and check your chest X-ray as well as answer any remaining questions. You will also be given a travel card that states you have metal bars in your chest and that MRIs can be performed. Pain medications will be given to you as needed. Please make sure that you have established a PCP at home. Regulations prevent prescribing certain medications across state lines and they may need their PCP to prescribe certain medications.
Activity
Some patients feel more comfortable sleeping with a wedge pillow for the first few weeks of recovery. Walking is encouraged, along with increasing your activity daily as tolerated. If you experience any emergent issues upon returning home please contact your local healthcare provider.
When to Get a Chest X-Ray
After surgery, the bars must be monitored to ensure stability and correct positioning. This is done through X-rays. Patients need to have an x-ray taken at the 6-week mark, the six-month mark, and then as directed.
Around the 2.5 to 3-year mark, call Dr. J's office to schedule bar removal.
Pectus Bar Removal
With Dr. Jaroszewski
Bar Removal
This is the final step in the pectus journey. The bars are removed as an outpatient procedure around three years after the original surgery. Patients will arrive several days before surgery for preoperative testing and consultation, where they will receive their surgery check-in time. The recovery time is much shorter, compared to bar insertion. Most patients are comfortable resuming normal activity a few days after bar removal.