Thoracoscopic Nuss Surgery

Nuss surgery is an elective procedure to help correct pectus excavatum. The surgeon makes two cuts into the side of the chest, below the armpit, and places a metal bar behind the breastbone/sternum, using a camera to see inside. The bar is then flipped to push out the breastbone/sternum. The bar is secured to the ribs to keep it in place. Sometimes multiple bars are necessary to push out the sternum.

Before Surgery

• Tests that may need to be completed prior to surgery (we will help set these up for you and discuss what needs to be done for your specific child):
  • CT Scan of the chest
  • Echocardiogram to evaluate the heart
  • Metal allergy testing depending on family history
  • Pulmonary Function Testing to evaluate the lungs
• You will meet with the anesthesiologist team prior to surgery to get ready for the operation and to discuss pain management techniques. Please practice the mindfulness/meditation techniques and incentive spirometry they discuss with you prior to surgery.

What to Bring to the Hospital

• Pack for about 4 days in the hospital.
• Bring any comfort items that you would like to have with you after surgery.
• Bring gum as chewing this after surgery can help your intestines “wake up.”
• Bring extra pillows for the car ride home.
• Please pack button down shirts/shirts that you can put on/off without putting your arms above your shoulders (i.e., no T-shirts).

Medications Prior to Surgery

We will order these medications for you:

• MiraLAX (polyethylene glycol): This helps you have a bowel movement. This should be taken twice daily for 3 days prior to the operation. Do not take the morning of the surgery. Take only once daily if you have very loose stools as a result.
• Senna and Colace: These also help you have a bowel movement. Take once daily for 3 days prior to the operation. Do not take the morning of surgery. Stop if having diarrhea.
• Gabapentin: This helps with nerve pain in preparation for surgery. Take nightly per prescription prior to the operation. Take a dose the morning of your surgery with a small sip of water.

After Surgery

Pectus Post-Op Schedule

Download Nuss Pectus Post-Op Schedule

What to Expect After Discharge

• Take it easy for the first 4-6 weeks after surgery.
• Slowly begin to increase your activity level, encourage walking frequently to start. Walking is excellent exercise and should be done frequently to build up your child’s strength. Your child should begin going for walks regularly as soon as you are home.
• You may bathe or shower on the fourth day after surgery.
• Paper Band-Aids (Steri-Strips) on the incisions will slowly come off as you bathe or shower. They can be completely removed after 7 days.
• Avoid heavy lifting (more than 10 pounds) for the first two months. Listen to your body; if it hurts, stop!
• No backpacks until cleared by physician at follow-up appointment (likely for the full first 3 months). You may want to get a rolling backpack.
• No karate, judo, gymnastics, or contact sports for when the bar is in place.
• After the operation and for the first month at home, bend at the hip when moving. Do not slouch or slump down when sitting. Good posture will help keep the bar in place.
• Sleep on your back for at least the first 2 weeks post discharge. Some patients find sleeping in a recliner chair helpful right after surgery.
• Continue to use your incentive spirometer frequently for the first 6 weeks after surgery, about every 2-3 hours while awake.
• Continue with Tylenol and ibuprofen as needed but your pain should begin to dissipate after the first month following surgery. When weaning pain medications at home, start with the mid-day doses first and then wean the night-time dose last to allow for a better sleep schedule.
• Random pinches of pain are normal, but if they last greater than 24 hours or do not respond to pain medicine, give our office a call as it is likely that you will need a chest x-ray!

Post-operative Emergency Information

• CPR can be performed if it is needed. Compressions will need to be delivered with more force because of the steel bar.
• Defibrillation for cardiac arrest may be performed if needed. Front to back defibrillation pad placement is necessary while the bar is in place.
• You will be given an application for a medical alert bracelet at discharge. The bracelet will alert Emergency Medical Services personnel and other healthcare providers about the steel bar.
• This will let them know to push harder during compressions and to place defibrillation pads correctly.
• If your child is scheduled for a Magnetic Resonance Imaging (MRI) exam in the future, inform the radiologist that your child has a pectus bar. An MRI can usually be done with the bar in place if the radiologist adjusts the MRI equipment settings.
• The metal bar may set off airport metal detectors. Make sure to tell airport security your child has a medical device. We can provide documentation of the bar if necessary.
• For the first 6 weeks after surgery, ride in the backseat of a car to prevent any possible trauma from an air bag.

Physical Therapy Guidelines

0-3 Weeks

• 10-pound weight restriction, avoid twisting and shoulder rotation
• 0-2 weeks: recliner or propped on pillows at night for comfort
• Aim for walking 3 times for 10 minutes
• 2-3 weeks: begin post-op range of motion exercises.
• Stop any activity that causes pinching or pulling in the chest

3-8 Weeks

• 10-pound weight restriction, avoid twisting and shoulder rotation
• Continue post-op range of motion exercises
• Can start core strengthening activities such as bridges, sit ups
• Aerobic conditioning activities: jogging, swimming (avoid free and back strokes), stationary bike
• Stop any activity that causes pinching or pulling in the chest

8-12 Weeks

• Avoid twisting and shoulder rotation
• PT referral (if indicated) focusing on middle trapezius, rhomboid, and core strengthening
• Slowly increase weight towards pre-op levels
• Progress aerobic conditioning towards pre-op levels
• Core/upper extremity strengthening exercises: planks, pull ups, push ups
• Stop any activity that causes pinching or pulling in the chest

12 Weeks+

• No contact sports while bar is in place, including volleyball, football, wrestling
• Limit activities that increase trunk rotation such as swinging the bat or golf club unless cleared by surgeon

When to Call After Surgery

• Call 911 if having difficulty breathing or turning blue.
• Any acute changes in chest wall appearance.
• Increased pain that does not respond to pain medication.
• Occasional popping sound is normal as the ribs slide along the bar, but call if there is a loud popping sound that is painful.
• Redness, swelling, or drainage from the incision sites.