Does your baby's chest feel sunken in? Let's talk about the Nuss Procedure!

Sometimes you may have seen some children with a condition where the middle part of their chest, where the breastbone (sternum) is, seems to have sunken in. This is medically called Pectus Excavatum . This condition can cause breathing difficulties and chest pain in some children. So, a successful, modern treatment for this is called the Nuss Procedure. Although the name may sound strange, this is a very important surgery. Today, we will talk about this simply and in a way that you can understand.

Simply put, what is this Nuss Procedure?

The Nuss Procedure is a minimally invasive surgery to correct Pectus Excavatum , or a sunken chest. This surgery can be performed through two or three very small incisions, rather than making a large incision in the chest like in the past.

This involves inserting a special wire (bar) made of titanium, custom-made to fit the child's body, into the chest to push the sunken chest bone forward and straighten it. This wire is left in the chest for about three years, and then it is removed again through a minor surgery.

What is the best age to have this surgery?

This surgery is usually performed on teenagers , around the age of 14. It is rarely performed on anyone younger than that. However, there is no upper age limit for this. This means that even an adult can have this surgery if they want to. However, the best results are achieved if this is done at a young age.

Why do we need to do this surgery?

The biggest advantage of this surgery is that the shape of the chest returns to its original shape immediately after the surgery. This means that the appearance is completely changed. It also helps the chest bone and cartilage develop properly while the wire is in place.

This is a good solution not only for appearance, but also for some of the health problems caused by this condition.

This surgery can relieve the following symptoms:

• Chest pain
• Difficulty breathing (especially when exercising)
• Heart palpitations
• Inability to exercise for long periods of time

What should you do before surgery?

A few days before the surgery, your doctor will order several tests for your child. These are essential tests to determine how well your child is suited for the surgery.

How is the surgery done?

The surgery can take about four hours. During this entire time, the child is under general anesthesia . This means that the child does not feel anything, he is completely asleep.

The surgeon follows these steps:

1. Small incisions: Two very small incisions are made in the skin on either side of the baby's chest.

2. Insertion of a camera: A small camera that can see inside the body is inserted through a single incision. This allows the doctor to perform the surgery while looking at a screen.

3. Pain control: Sometimes, to reduce pain after surgery, a procedure called ``Cryoablation'' can be used to temporarily deactivate nerves in the chest. This freezes the nerves.

4. Insertion of the wire: Through the other incision, a curved metal wire (bar) specially designed for the child, based on previous measurements, is inserted, passed under the sunken breastbone, and pushed forward.

5. Fixing the wire: This wire is then secured with stitches to prevent it from touching the chest wall. Sometimes, if one wire is not enough, two or three can be used.

6. Finishing the surgery: Finally, the camera is removed and the small incisions are sewn up.

What happens after the surgery and how is the pain?

Usually, the child has to stay in the hospital for a day or two. There is pain after the surgery. For this reason, the child is given several different types of painkillers. Some of them can be quite strong.

From the day after the surgery, the child is taught to sit up in bed, take deep breaths, and is encouraged to walk around a bit. These things are very important for the healing process. Also, painkillers can cause constipation, so they are given medication for that as well.

Are there risks and complications?

As with any surgery, there are some risks involved, but these are very rare.

• Bleeding
• Infections
• Pain
• Movement from the inserted wire

To prevent the wire from moving...

The cord is more likely to move during the first four to five weeks, so you should teach your child to be especially careful about these things:

• Sit with your back straight.
• Bend forward only at the waist.
• When sleeping in bed, don't roll over. You should sleep on your side.

How long does it take to fully recover?

It can take up to six months to fully recover, but most children can resume normal activities much sooner . They can usually go to school within a month.

However, it is not recommended to do heavy lifting, contact sports, and twisting exercises for several months, as they can move the wire. Your doctor will tell you in detail what activities you can and cannot do.

When do you need to see the doctor?

You need to be very careful about your child after the surgery. If you have any of the following symptoms, call your doctor immediately.

Also, you must take your child to the clinic on the dates the doctor gives you. Each time, the doctor will check to see if the wounds have healed, how the chest is shaped, and if the wire is in place.

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