Introduction
Pectus excavatum, a congenital chest wall deformity characterized by a sunken breastbone (sternum) and ribs, can have physical and psychological impacts on patients. In Albany, there are several well - reputed hospitals that offer high - quality correction surgeries for this condition. This article aims to provide a comprehensive introduction to these hospitals, the surgical procedures available, patient selection criteria, and other related aspects.
Understanding Pectus Excavatum
Pectus excavatum occurs in approximately one out of 1,000 children. It is about five times more common in boys than girls and is usually noted at birth as a mild condition but can become progressively more pronounced over time. The deformity can lead to additional symptoms and conditions such as chest pain, shortness of breath (especially on exertion), mitral valve prolapse, associated syndromes affecting skeletal growth, and scoliosis.
Diagnosis
Chest wall deformities can be evident in infancy, but many also develop or become more obvious as children grow. Abnormalities are usually noted by the parents, but may be evident only to the physician and found during routine chest examination. Other deformities may be noted by the patient. To evaluate pectus deformities, doctors commonly use chest x - rays (both front and side views) or a chest CT scan. To reduce radiation exposure, the severity of the deformity can often be assessed with just x - rays using measurements like the pectus severity index or haller index. Additional tests may include pulmonary function tests to check how well the lungs are working and an echocardiogram, an ultrasound of the heart to assess its function and structure.
Non - Surgical and Surgical Treatment Options
Non - surgical options for pectus excavatum include the vacuum bell, a non - surgical option to ‘suck’ the breast bone or sternum forward. It is a device worn over time and may improve the pectus excavatum particularly in young patients, but its long - term results remain unclear. Patients who are looking to avoid surgery or who do not qualify for surgery have the option of choosing non - surgical treatment pairing vacuum bell therapy with exercises and stretches. Approximately 80 percent saw an elevation greater than 1 cm within 3 months, approximately 20 percent saw complete correction within 6 months, and approximately 13.5 percent saw complete correction within 18 months.
When it comes to surgical options, the two most common types of corrective surgical repair of pectus excavatum are the minimally invasive repair of pectus excavatum (MIRPE) or Nuss procedure and the ‘open’ modified Ravitch operation.
| Procedure | Description | Advantages | Recovery |
|---|---|---|---|
| Nuss Procedure | A keyhole operation involving insertion of a metal bar behind the breastbone to correct the pectus excavatum. A small video camera called a thoracoscope is placed through one of the incisions to view inside the chest. A curved steel bar shaped to fit the child is inserted through the incisions and placed under the breastbone. The bar is rotated to press against the chest wall, pushing the ribs and sternum outward. The bar is left in place for at least 2 years to help the breastbone grow properly. | Smaller incisions and reduced scarring, reduced operating time, an approximate 90 percent decrease in blood loss, an early return to regular activity, excellent cosmetic results | Chest deformity is corrected right away. Usually quicker than the Ravitch procedure. Leads to less blood loss, smaller incisions, and minimal scarring. Recovery time is faster than traditional methods, with a usual hospital stay of 1 to 2 days. The bar is removed in a brief outpatient procedure once the chest has fully healed. |
| Modified Ravitch Operation | A more traditional open operation. The surgeon makes a cut across the front part of the chest. The deformed cartilage is removed and the rib lining is left in place to allow the cartilage to grow back correctly. A cut is made in the breastbone, which is moved to the correct location. The surgeon may use a metal strut to hold the breastbone in the normal position until it heals. A tube may be placed to drain fluids that build up in the area of repair. The incisions are closed at the end of the surgery, and the metal struts are removed in 6 to 12 months through a small cut in the skin under the arm. | Well - established method for correcting chest wall deformities | The recovery period includes a hospital stay of 3 to 5 days. The stabilizing bar is usually removed after about 6 months. By then, new cartilage will have formed to help support the sternum and ribs. |
Well - Reputed Hospitals in Albany for Pectus Excavatum Correction Surgery
Albany Medical Center
Albany Medical Center is highly regarded in the region for its surgical services. The Bernard & Millie Duker Children's Hospital at Albany Medical Center offers top - level pediatric surgical care. As an academic health system, its pediatric surgeons are highly trained experts in their field, performing the latest techniques in pediatric surgical care. They have the technology and equipment to perform advanced surgical techniques to treat a wide range of conditions and illnesses, including pectus excavatum.
The hospital takes a family - centered approach, recognizing the important connection between the physician, child, and parents/caregivers. Their team meets the physical and emotional needs of children from newborns to adolescents. In addition to pediatric general surgery, they have specialty - trained surgeons in pediatric cardiothoracic surgery, neurosurgery, orthopedic, otolaryngology surgery, plastic surgery, and surgical oncology. Their team has special training and extensive experience in a wide range of procedures from trauma surgery to repairing complex birth defects and numerous elective surgical procedures.
For pectus excavatum, the hospital offers both traditional surgery and minimally invasive procedures, including the use of the da Vinci robotic surgical system. Minimally invasive procedures enable children to recover faster with fewer complications, and most of the time they can be performed on an outpatient basis so children can get back home. To make an appointment with Albany Medical Center, one can call 518 - 262 - 5831.
St. Peter's Hospital - Albany
St. Peter's Hospital - Albany is ranked #1 in Albany, NY according to US News Best Hospitals. It is high - performing in 2 specialties and 15 procedures/conditions. While specific details about its pectus excavatum correction surgery may not be as comprehensively available as Albany Medical Center, its high - performance ranking indicates that it has a reputation for providing quality surgical care. It likely has experienced surgeons and a well - equipped medical facility to handle pectus excavatum cases.
Albany Stratton Veterans Affairs Medical Center
This medical center serves veterans in the Albany area. Although it may not be as well - known specifically for pectus excavatum correction surgery as a dedicated pediatric or general surgical hospital, it has the resources and expertise to provide comprehensive medical and surgical care. For veterans who suffer from pectus excavatum, the center may be able to offer treatment options. They may also have access to specialized services related to any associated medical conditions that a veteran with pectus excavatum may have.
Patient Selection and Pre - operative Assessment
Patient Selection
The decision to have surgical correction is largely based on the severity and type of pectus deformity, patient choice including the psychosocial impact and physical or functional issues. In patients with symptoms, further investigations should be considered to identify patients with pectus - associated functional impairment including musculoskeletal issues. Relative contraindications to surgical correction include complex congenital heart and lung problems and neurodevelopmental disorders.
Typically, a Haller index of > 3.25 is considered an indication for surgery. However, this may be helped by a correction index (CI) which accounts for abnormal chest shapes. A CI > 28% correlates with a Haller index of > 3.25.
Pre - operative Assessment
All patients need to be carefully assessed for symptoms and severity of the pectus deformity. Their psychological concerns should be addressed. If symptoms are significant, they should be investigated appropriately. Detailed radiology may help the surgeon assess further, particularly if the deformity is severe, asymmetric, or more complex.
| Indication | Investigation before Corrective Surgery |
|---|---|
| General | All chest wall measurements, medical photography and/or 3D body scan |
| Assessing severity | Chest CT or MRI to assess severity and associated features such as sternal rotation as well as calculation of HI and CI |
| Breathlessness | Lung function tests. Consider CPET |
| Palpitations, syncope or pre - syncope | ECG, transthoracic echocardiogram. Consider stress echocardiogram |
| Significant psychological features | Psychological assessment |
| Features of Marfan syndrome | Chest CT, transthoracic echocardiogram, genetic referral for fibrillin - 1 mutation and ophthalmology review |
| Those undergoing bar insertion including Nuss procedure | Metal allergy testing (titanium bars can be considered if there is a metal allergy) |
Recovery and Post - operative Care
The recovery process after pectus excavatum correction surgery varies depending on the type of procedure performed. For the Nuss procedure, patients usually have a shorter hospital stay, often 1 to 2 days. They can return to regular activity relatively early. However, they need to avoid strenuous activities for a certain period to allow the chest to heal properly. The bar inserted during the Nuss procedure remains in place for at least 2 years to help the breastbone grow correctly, and it is removed in a brief outpatient procedure once the chest has fully healed.
For the modified Ravitch operation, patients typically stay in the hospital for 3 to 5 days. After the stabilizing bar is removed, which is usually after about 6 months, new cartilage will have formed to support the sternum and ribs. Pain is common after both procedures. In the first few days, patients may receive strong pain medicine through an IV or an epidural, and then pain is usually managed with oral medicines. Patients may also have tubes in the chest around the surgical cuts to drain extra fluid, and these tubes are removed once they stop draining, usually after a few days. After surgery, patients are encouraged to sit up, take deep breaths, and start walking to aid in the healing process.
Conclusion
In conclusion, pectus excavatum is a congenital chest wall deformity that can be effectively treated through surgical and non - surgical means. In Albany, hospitals such as Albany Medical Center, St. Peter's Hospital - Albany, and Albany Stratton Veterans Affairs Medical Center offer high - quality surgical options for pectus excavatum correction. These hospitals have experienced surgeons, advanced medical technology, and a patient - centered approach to ensure the best possible outcomes for patients. The choice of surgical procedure depends on factors such as the severity of the deformity, the age of the patient, and associated medical conditions. Proper patient selection and pre - operative assessment are crucial to ensure the safety and effectiveness of the surgery. Additionally, a comprehensive post - operative care plan is essential for a smooth recovery.
If you or someone you know is considering pectus excavatum correction surgery, we encourage you to explore the options available at these well - reputed Albany hospitals. Contact them for more information and schedule a consultation to discuss the best treatment plan for your specific situation. Share this article with others who may be interested in learning about pectus excavatum and its treatment options in Albany.
