From the Research
The treatment approach for pectus excavatum should prioritize the Nuss procedure for moderate to severe cases, considering its efficacy and safety as demonstrated in recent studies, such as 1, which shows comparable risks of major complications between young and adult patients.
Overview of Pectus Excavatum Treatment
The treatment of pectus excavatum depends on the severity of the condition and the presence of symptoms. Mild cases may not require treatment beyond monitoring, while moderate to severe cases causing cardiopulmonary symptoms or significant psychological distress necessitate surgical correction.
Surgical Options
- The Nuss procedure is the most common surgical approach, involving the placement of a curved metal bar beneath the sternum to push it outward, typically performed in adolescents when the chest wall is still flexible 2.
- The alternative Ravitch procedure involves removing abnormal cartilage and straightening the sternum directly.
- The choice between these procedures should be based on the individual patient's condition, with considerations including the severity of the deformity, the patient's age, and the potential risks and benefits of each procedure 3.
Non-Surgical Options
- Vacuum bell therapy, which uses suction to gradually lift the sternum, is a non-surgical option for patients who are not candidates for surgery or prefer not to undergo surgical correction.
- Physical therapy to improve posture and chest muscle strength can also be beneficial, especially in mild cases or as an adjunct to surgical treatment.
Considerations for Treatment Decisions
Treatment decisions should consider both physical symptoms, such as exercise intolerance, chest pain, and breathing difficulties, and psychological impact, with timing of intervention ideally during the growth spurt of adolescence for optimal outcomes 1. The risk of complications, including chronic postoperative pain, should also be discussed with patients, particularly adults, as noted in 1.
Recent Findings and Recommendations
Recent studies, such as 4, highlight the importance of perioperative considerations in anesthesia for minimally invasive repair of pectus excavatum, emphasizing the need for effective pain management and reduction of surgical stress to improve patient outcomes. Given the most recent and highest quality evidence, the Nuss procedure is recommended for eligible patients due to its established safety profile and effectiveness in correcting the deformity, as supported by 1 and 4.