Doctor Nguyen Do Trong, a specialist in pediatric surgery, stated that Khang's Haller index, which assesses the severity of pectus excavatum, was 2,9, compared to the normal 2,5. Although it had not yet affected his heart or lungs, the indentation caused an unbalanced chest, impacting the patient's psychological well-being.

Doctor Trong prescribed endoscopic surgery using the Nuss procedure to place a chest bar. The patient received general anesthesia and a bilateral erector spinae plane block, combined with intravenous pain relief, to manage post-operative pain. After measuring and bending the bar to fit the patient's chest shape, the surgical team separated muscle layers, created a tunnel through the pleural cavity, behind the sternum and pericardium. The team inserted the bar through this tunnel, then rotated it 180 degrees to elevate the sternum and sunken ribs back to their normal anatomical position.

According to Doctor Trong, the Nuss procedure is a minimally invasive method with small incisions. Patients may experience mild pain for the initial two to four days as the metal bar directly impacts the chest wall.

Khang's health stabilized after five days, and he was discharged.

Doctor Trong (second from left) and the pediatric surgery team performing chest bar placement surgery on Khang. *Photo: Tam Anh General Hospital*

Pectus excavatum is a congenital chest wall deformity where the lower costal cartilages develop excessively or unevenly, pushing the sternum backward and creating an indentation in the chest. This condition can be detected early in the first year after birth or later as the child grows, and it is more common in boys. Severe cases can compress the heart and lungs, leading to symptoms such as: shortness of breath, coughing, chest tightness, fatigue, dizziness, breathlessness, exhaustion during exercise, respiratory infections, and cardiac arrhythmias.

According to Doctor Trong, the optimal time for surgery is between eight and 14 years old, ideally before 12. At this age, the chest bones are still pliable and highly elastic, making reshaping easier, reducing pain, and limiting recurrence. Early treatment leads to better corrective outcomes and minimizes impact on other organs.

After surgery, children can resume normal activities but must avoid contact sports for the initial three months. Patients need to maintain an upright chest posture to prevent bar displacement and avoid lifting heavy objects to reduce the risk of lung collapse and recurrence. Doctors will remove the bar after two to three years, once the sternum has stabilized in its new shape.

Parents should seek medical consultation if they notice any chest abnormalities in their child, especially if accompanied by symptoms like: shortness of breath or fatigue during strenuous activity, to ensure timely intervention.

Gian Don

*Patient's name has been changed