What is the Nuss Procedure?

A Nuss procedure is a surgical treatment for pectus excavatum, where the chest is sunken. In this surgery, a metal bar is inserted behind the sternum to pop it out and hold the chest in place. The surgery itself does not take very long, but the recovery tends to be painful and lengthy. People of all ages can be candidates for a Nuss procedure if they experience medical complications like difficulty breathing and pressure on the heart as a result of their sunken chests. This surgery is generally not recommended for cosmetic reasons.

Prior to the development of the Nuss procedure in the 1990s, treating a sunken chest was extremely challenging. The surgical options were invasive and presented a number of risks, as the patient's chest had to be essentially rebuilt. In the Nuss procedure, a minimally invasive approach is taken with incisions through the side of the chest to insert the bar or bars, in the case of someone with a big chest. A camera is used to monitor positioning and make sure the bar is anchored in the correct place.

Risks of a Nuss procedure can include infection in the chest or around the insertion site, as well as damage to the contents of the chest cavity. These risks are generally deemed acceptable when a concavity in a patient's chest is so severe that the patient's quality of life is reduced with issues like labored breathing. Using cameras in the procedure to track the movement of the bar and make sure it is not compromising any internal organs also reduces risk.

Patients will need to stay in the hospital for around five days after a Nuss procedure. While in the hospital, aggressive postoperative pain management is provided and the patient is required to lie very still to avoid dislodging the bar while it settles in place. When patients are allowed to go home, their activities are restricted for several weeks while they recover. Heavy exercise, weight lifting, and similar activities can endanger the patient in the early stages of healing.

After several years, the bar can be removed. Some patients prefer to simply leave it in. The removal procedure is not as painful as the original surgery and can be done relatively quickly. The chest should be stabilized from several years with the bar in place, reducing the risk that it will start to sink again. If there are concerns, the bar can simply be left in for a longer period of time.