Perioperative management - Pectus excavatum correction

• Patient's desire
  • Particularly during adolescence, there is an impairment of self-esteem, leading to significant psychological stress.
• Haller index > 3.25
• Limitation of physical endurance
  • Here, the limitation of cardiac pump function is particularly relevant, while lung restriction often plays a minor role.
• Chest and/or back pain
  • Chest deformity or resulting misalignments of the spine, such as scoliosis or kyphosis, can promote pain.
• Rare: cardiopulmonary symptoms such as arrhythmias and/or frequent respiratory infections

• absolute contraindication: 
  • Inability to undergo anesthesia
  • Allergy to the metal used
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• relative contraindication:
  • Promising conservative therapy attempt in mild cases.
  • In some cases, another surgical method may be recommended, especially in adult patients due to ossified cartilage and/or significant asymmetry or severity of pectus excavatum.

• MRI of the thorax (Reduction of radiation exposure compared to computed tomography with the same diagnostic value regarding pectus excavatum)
• Allergy test for the metal used in the bar
  • Note: Even a negative allergy test does not exclude an allergic reaction after the surgery.
• Echocardiography
• if applicable, pulmonary function test and spiroergometry
• if applicable, psychological assessment

• Shaving if necessary
• Single-shot antibiotic Cefuroxime 1.5g
• Epidural catheter or paravertebral block as per patient's request

Since this is a highly elective procedure, in addition to the general surgical risks such as thrombosis, embolism, allergy, infection, bleeding, and wound healing disorder, the sometimes rare but serious complications must also be discussed in detail:

• prolonged, severe pain after surgery
• pneumothorax
• dislocation of the metal bar with possible need for re-operation
• allergies to the metal, possibly necessitating explantation
• injury to the internal thoracic vessels with subsequent bleeding
• sternum fracture
• injury to the lung parenchyma
• injury to the heart, for example, perforation with potentially fatal outcome