From the Research
Surgical correction, specifically the Nuss procedure, is recommended for moderate to severe cases of pectus excavatum causing cardiopulmonary symptoms or significant psychological distress, as it has been shown to improve lung function, exercise capacity, and reduce depression and anxiety 1.
Overview of Pectus Excavatum
Pectus excavatum is a congenital chest wall deformity characterized by a sunken or depressed sternum, creating a concave appearance of the chest. The condition occurs due to abnormal growth of the costal cartilages connecting the ribs to the sternum, causing the sternum to be pulled inward during development.
Treatment Options
Treatment depends on the severity of the condition and associated symptoms. For mild cases without physiological impairment, no treatment may be necessary. Non-surgical options include vacuum bell therapy, which uses suction to gradually lift the sternum, and physical therapy to improve posture and chest expansion.
Surgical Approaches
The two main surgical approaches are the Nuss procedure (minimally invasive, using a curved metal bar to reshape the chest) and the Ravitch procedure (open surgery involving cartilage removal and sternum repositioning). The Nuss procedure has been shown to be safe and effective in both young and adult patients, with a low risk of major complications 2, 3.
Outcomes and Complications
Studies have reported significant improvements in lung function, exercise capacity, and reductions in depression and anxiety after surgical correction 1, 4. However, chronic postoperative pain is a common complication, particularly in adult patients 3. An epidural-based analgesic regime has been shown to be effective in managing postoperative pain, with low pain scores and few acute complications 5.
Recommendation
The Nuss procedure is the recommended surgical approach for moderate to severe cases of pectus excavatum, due to its minimally invasive nature and low risk of major complications 1, 2, 3. Psychological support is also important, as the visible deformity can affect body image and self-esteem, particularly during adolescence when the condition often becomes more pronounced.