NUSS Surgery Process
Detailed information and resources on the surgical procedure for correcting pectus excavatum, including pre-operative preparations, the surgical technique, and post-operative care.
Your doctor will diagnose your disease, give you detailed information about the problems it may cause and treatment methods. He recommends you the Nuss operation.
The patient or family who decide to have surgery within all information reaches our clinic again, and the appropriate surgery date is mutually determined.
4 Days Before the Surgery
1- For patients and individuals under the age of 18, both parents (or all legal guardians) apply to our clinic together. 2- The metal test material to evaluate whether the patient has a metal allergy is adhered to his body and he is asked not to remove it until the day of surgery. 3- Informed consent form is signed mutually and a copy is delivered to the patient or their guardians. 4- The patient and his guardians are directed to the relevant employee at the contracted hospital. When they arrive at the hospital In the stewardess of the employee, tests such as chest X-ray, blood tests and EKG are performed for preoperative evaluation. As a result of these examinations, it is evaluated by the anesthesiologist and the suitability for the operation is determined in terms of anesthesia. 5- If the anesthesiologist deems it necessary, opinions and examinations may be requested from the physicians of other departments (eg cardiology, etc.), and the anesthesiologist may want to decide on the suitability or unsuitability of surgery accordingly. But most of the time it won't be needed. 6- If, as a result of all these evaluations, the anesthesiologist decides on suitability for surgery, this situation is shared with the patient or guardians, and this time the informed consent form for the patient to receive anesthesia is mutually signed.
1- Since surgeries are usually performed in the morning, it is necessary to wake up early in the morning and set off. 2- If a surgery time such as 08.30 in the morning is determined, hospitalization procedures should be started by being in the emergency department of the relevant hospital at 07.00 at the latest. 3- When you go to the service, some documents will be signed by the nurse and if your doctor requests, an intravenous line will be opened and some drugs will be given. 4- When going down to the operation, the patient will be asked to take off his clothes and put on the aprons of the hospital. 5- After your preparations are completed, the patient is taken to the operating room by the relevant hospital staff.
After Surgery (Day 1)
1- A sample will be taken for blood analysis by your nurses early in the morning, and you will be taken to the x-ray film by the hospital staff. 2- Later, your doctor will come to the visit and evaluate the patient with all these results, and according to these results, he will prepare the new day's medicine list (order) and give it to your nurses. 3- Generally, the patient, who is quite restless and symptomatic in the early postoperative period on the first day, is better at the second visit of the first day, and is expected to feel much better at the morning visit on the second day. Accordingly, the drugs given are slightly reduced. 4- He can do all the movements, walk, eat as he wishes and meet his needs himself, except for the 1-month restriction on the arm movements specified before the surgery.
1- On the 11th day, you will need to make an appointment to the office free of charge to see a chest x-ray from the front and side and to check the wound sites. The doctor will direct you to a imaging center. 2- In this examination, a report will be given to the patient by your doctor. In this report, the rest duration that patient need will be written. And this report will include that the patient has metal bar(s) inside and it (or they) may beep while passing the X-ray devices and this situation is normal. Moreover,it wil be written that the metal impant(s) are compatible with MRI and in the process where the metal implant must stay in the patient, it will not be a problem when the patient needs an MRI. The report will also include some informations such as the patient should avoid arm movements and heavy exercises in the first three months of the surgery, that the patient should avoid contact sports and severe blows until the metal bar on his (or her) chest is removed. And that if the patient is a student, the report will include the information that he (or she) must be exempted from physical education classes until the bar will be removed. 3- In this examination, an X-ray identification card in English will be given to the patient by the supplier of the metal bar, valid also abroad. This card contains the information that the metal bar inside the patient may beep while the patient is passing through X-ray devices, and this card will help the patient a lot while passing through security points in places such as airports. 4- On the 11th day, you can start applying the cream prescribed by your doctor to the wound so that less scars remain on the wound. For maximum effect, it is recommended to apply it to the incision sites by pressing and rubbing 3 times a day for at least 6 months. 5- It is strongly recommended that the incision sites are not exposed to direct sun for 6 months or a year if possible, to reduce scarring. 6- In the first month of the operation, you will need to make another free appointment at the office to see a chest x-ray from the front and side and for a general examination.
After Surgery (Month 6, Year 1 & Year 2)
For the three aforementioned dates, you will still only need to see an anterior chest x-ray (PAAC) and consult your doctor for a general examination each time. It should be noted that sometimes your doctor may decide to remove the bar in the second year instead of the third year. This decision to be promoted is a necessary decision for your health. In such cases, it is strongly recommended that you do not delay these intermediate examinations in order to avoid problems.
Bar Removal Surgery
1- The night before and morning of the surgery procedures are the same as the previous surgery. 2- After the surgery, the patient is taken to the ward and evaluated by your doctor. 3- A few hours of service rest is done. When the time determined after the surgery is completed, the first Similar to the surgery, you start to feed first with water and then with liquid foods. 4- On the same day, your blood test will be taken and you will be taken to the radiology unit for a lung X-Ray will be taken. 5- In the afternoon visit of your doctor, after your blood test, chest X-ray and general condition are evaluated, your discharge is decided if deemed appropriate (mostly appropriate). 6- The bar and stabilizers removed from your body are delivered to the patient in a disinfected state. 7- Your doctor will fill in the information management system to send hospital the summary of the hospitalization (epicrisis) form that will be given to you by the hospital management. And the doctor also will prescribe the drugs you will use after discharge.
Night Before the Surgery
1. It can be eaten and drunk until 00.00. In particular, the benefits of a high-carbohydrate diet have been shown. 2. After 00.00, the patient should not eat or drink anything. 3. If your doctor has previously recommended the use of certain medications, You must use drugs.
After Surgery (Day 0)
1- After the operation, the patient will be taken out of the operating room to the recovery unit in the operating room for a while and will be rested here under the supervision of the anesthesia team until it is concluded that he is completely out of the effect of anesthesia. 2- Later, he will be taken to his room on a stretcher by the hospital staff and taken to his bed. 3- Since the anesthetic effect continues for a certain period of time after the surgery, it can also affects gastrointestinal movements. Since there will be inactivity due to the effect of anesthesia, nothing is given orally to prevent the patient from vomiting. 4- The need for water in this process is met by intravenous fluids. In addition, drugs are given by intravenous or intramuscular injection. 5- It is normal for the patient to feel a little restless, to have symptoms such as nausea and vomiting, and to say that he feels a slight amount of pain during this first service admission. It is very important that the people who will accompany the patient, being aware of this situation, accept it as normal and not push the patient who has just come out of the surgery to more panic. 6- Your doctor will perform the first examination of the patient in his bed in the service after the surgery and will inform the attendants about the surgery. Your doctor will plan the drug treatments determined according to the results of this examination, give an order to the service nurse and send them in written form, and the service nurse will arrange the patient's medications accordingly. 7- In line with your doctor's recommendations, the patient's do's and don'ts will be communicated by the service nurse. 8- When the time determined by your doctor after the surgery has expired, the patient will start to be fed orally, on the condition that it starts with water first. 15-20 minutes after drinking water. If nausea and vomiting do not occur, feeding with liquid foods will begin (fruit juice, soup, yoghurt, etc.). If there is no sign of vomiting after 1-2 hours of liquid food feeding, the patient can normally be fed with solid foods. 9- After your doctor visits you again in the afternoon and checks you once again (probably, he will see you in a better condition with the drugs given compared to the early period after the surgery in the first visit), if he deems it appropriate, he will first make the patient sit for a while and then start walking in the room. In this case, if there is no problem, he will ask you to walk longer distances in the evening shuttle. (it should be noted that it is very beneficial to move and walk on the first day).
1- Your doctor will see you on the morning of your discharge and decide on your discharge. 2- Afterwards, the doctor will send your hospitalization summary (epicrisis) form to the hospital on the information management system. Epicrisis will be given to you by the hospital management. 3- The doctor will prescribe the drugs you will use after discharge. The patient (or family) buys the prescribed drugs and should be strictly applied at home/hotel. 4- Water should not touch the wound site until the end of the 10th day after surgery. During this period, in order to do it, the patient (or family) should buy waterproof tapes sold by medical markets and stick it on the wound while taking a bath.
After Surgery (Month 3)
You will only need to visit your doctor to see an anterior chest x-ray (PAAC) and decide the patient should start sports or physical therapy activities. As a result of this examination, your doctor may recommend physical therapy movements to the patient and give him the appropriateness to start sports.
After Surgery (Year 3)
1- You need to apply to the clinic with a bar removal plan. 2- After the decision to remove the bar with the examination made by your doctor, mutual compatibility the date of surgery is clarified according to the condition 3- For bar removal surgery, mutually agreed by your doctor and the patient or their guardians. Informed consent form is signed and a copy is delivered to the patient or their guardians. 4- The patient and his guardians are directed to the relevant employee at the contracted hospital. The patient's first Nuss surgery Anesthesia approval is obtained with a similar process.
Discharge After Bar Removal
1- Water should not touch the wound site until the end of the 10th day after surgery. In this process, the patient should buy waterproof tapes and stick it on the wound, which is sold by medical markets, so that he can take a bath. 2- If the operation day is counted as 0, you can apply to your doctor's office free of charge for a wound control on the 3rd day after the operation. Patients coming from a remote area can have these checks done by any doctor in their city. In this examination, your doctor will open the wound dressings, after checking your wound, apply a baticon to the wound area and ask not to cover it until the baticon dries on the wound. Once the baticon dries, it will leave the wound open, not reclose it. This is the application where wound healing is at the highest level. 3- On the 11th day, you can start to apply the cream prescribed by your doctor to the wound so that there are fewer scars on the wound. For maximum effect, it is recommended to apply it to the incision sites by pressing and rubbing 3 times a day for at least 6 months. 4- It is highly recommended that the incision sites are not exposed to direct sun for 6 months or a year, if possible, to reduce scarring.