What To Expect: Surgery

The days before surgery

To avoid discomfort due to constipation your child may experience after surgery, we recommend starting your child on a gentle laxative regimen 2 days prior to surgery. Please have your child drink one bottle of magnesium citrate (300 mL) once a day for the 2 days prior to the surgical procedure date. In addition, we ask that your child take only clear liquids (i.e. water, juice without pulp, broth, lemonade, gelatin, soup broth) the day prior to the procedure.

Magnesium citrate may be purchased over the counter at most drug stores and grocery stores.

Before surgery

Once surgery is scheduled, you will be provided with specific information about when and where to arrive for surgery. You will also be contacted for by our anesthesia department to discuss your child’s anesthetic plan and answers any questions you may have. Your child will be given an incentive spirometer (a device used to help keep the lungs healthy after surgery) to practice deep breathing exercises prior to surgery. Please have your child use the incentive spirometer twice daily as directed until the surgery date and upon returning home from surgery. You will be given antiseptic wipes to clean your child’s chest the night before and the morning of surgery to help reduce the risk of infection.

The hospital stay

For most pectus excavatum or pectus carinatum surgical repairs, patients should expect to stay in the hospital for four to seven days. Patients will be able to eat and move around immediately after surgery. During the hospital stay, the goals of care will be to:

• Optimize pain control
• Work with physical therapy to develop strategies to transfer and move around comfortably
• Monitor the incisions to ensure proper healing
• Practice taking deep breaths using the incentive spirometer to help fully re-expand the lungs after surgery and prevent fluid or mucus build-up that could lead to the development of pneumonia

Pain control methods

We offer a wide variety of pain control options during and after surgery, some not available in most other children’s hospitals.

As expected, we offer cryoablation (freezing of the nerves to block pain receptors) and traditional catheters, including spinal epidurals. We often use a rare, innovative technique called an erector spinae plane (ESP) block, where a catheter is inserted into nearby spinal muscles to continuously infuse local anesthesia, rather than inserting a catheter next to the spinal cord.

The benefits of the ESP block is that it is safer, more effective, and often means a shorter hospital stay over traditional spinal epidurals, which often require a week in the hospital. We also speed up recovery with alternatives to narcotic pain medications after surgery.

At Stanford Medicine Children’s Health, our Pain Management program continually explores new and better ways to manage pain. These often balance traditional methods with complementary medicine, including physical therapy, occupational therapy, intravenous patient-controlled analgesia, acupuncture, biofeedback, cognitive-behavioral techniques, yoga exercises, and much more.

Returning home and follow-up

Your child will be discharged home once his/her pain is well controlled and he/she can move around independently. Your child will be provided with exercises to help aid in your child’s recovery at home. There will be minimal required care for incisions. We will typically see your child for follow-up 1 month, 3 months, 6 months, and 1 year after discharge. We will then arrange for annual follow-up after surgery to evaluate your child’s progress and discuss optimal timing for bar removal.