Non-surgical Treatment of Pectus Excavatum

Overview

Journal J Vis Surg

Publisher AME Publishing Company

Specialty General Surgery

Date 2017 Oct 29

PMID 29078491

Citations 3

Authors

Frank-Martin Haecker

Sergio Sesia

Affiliations

Soon will be listed here.

Abstract

Background: Previously used procedures to correct pectus excavatum (PE) were largely based on surgical techniques like Ravitch procedure or the minimally invasive Nuss technique. Conservative treatment with the vacuum bell (VB) to elevate the funnel in patients with PE, represents a potential alternative to surgery in selected patients.

Methods: A suction cup is used to create a vacuum at the anterior chest wall. Three different sizes as well as a model fitted for young women of VB exist which are selected according to the individual patients age. A patient-activated hand pump is used to create a vacuum at the anterior chest wall. When creating the vacuum, the lift of the sternum is obvious and remains for a different time period. The device should be used for a minimum of 30 minutes (2/day), and may be used up to a maximum of several hours daily. We have an IRB approval for it. Since this paper was conducted as a retrospective study, we did not have to have informed consent of every patient.

Results: CT-scans showed that the device lifted the sternum and ribs immediately. In addition, this was confirmed thoracoscopically during the MIRPE procedure. Preliminary results published within the last 10 years proved to be successful.

Conclusions: The VB has been established as an alternative therapeutic option in selected patients suffering from PE. The initial results proved to be dramatic, but long-term results comprising more than 15 years are so far lacking, and further evaluation and follow-up studies are necessary.

Citing Articles

New Computerized Planning Algorithm and Clinical Testing of Optimized Nuss Bar Design for Patients with Pectus Excavatum.

Papp J, Kiss A, Balogh K, Kostyal L, Toth I, Gall T Med Sci Monit. 2024; 30:e943705.

PMID: 38760925 PMC: 11110638. DOI: 10.12659/MSM.943705.

Finding suitable candidates for vacuum bell therapy in pectus excavatum patients.

Yi E, Lee K, Jung Y, Chung J, Kim H, Lee S Sci Rep. 2021; 11(1):22787.

PMID: 34815487 PMC: 8611086. DOI: 10.1038/s41598-021-02250-x.

Vacuum bell therapy.

Haecker F, Sesia S Ann Cardiothorac Surg. 2016; 5(5):440-449.

PMID: 27747177 PMC: 5056932. DOI: 10.21037/acs.2016.06.06.

References

Haecker F . The vacuum bell for conservative treatment of pectus excavatum: the Basle experience. Pediatr Surg Int. 2011; 27(6):623-7. DOI: 10.1007/s00383-010-2843-7. View

Becmeur F, Gomes Ferreira C, Haecker F, Schneider A, Lacreuse I . Pectus excavatum repair according to Nuss: is it safe to place a retrosternal bar by a transpleural approach, under thoracoscopic vision?. J Laparoendosc Adv Surg Tech A. 2011; 21(8):757-61. DOI: 10.1089/lap.2011.0035. View

Berberich T, Haecker F, Kehrer B, Erb T, Gunthard J, Hammer J . Postpericardiotomy syndrome after minimally invasive repair of pectus excavatum. J Pediatr Surg. 2004; 39(11):e1-3. DOI: 10.1016/j.jpedsurg.2004.07.029. View

Haecker F, Bielek J, von Schweinitz D . Minimally invasive repair of pectus excavatum (MIRPE)--the Basel experience. Swiss Surg. 2004; 9(6):289-95. DOI: 10.1024/1023-9332.9.6.289. View

Croitoru D, Kelly Jr R, Goretsky M, Lawson M, Swoveland B, Nuss D . Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg. 2002; 37(3):437-45. DOI: 10.1053/jpsu.2002.30851. View

Park H, Lee S, Lee C . Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg. 2004; 39(3):391-5. DOI: 10.1016/j.jpedsurg.2003.11.012. View

Kelly R, Goretsky M, Obermeyer R, Kuhn M, Redlinger R, Haney T . Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010; 252(6):1072-81. DOI: 10.1097/SLA.0b013e3181effdce. View

Haecker F, Mayr J . The vacuum bell for treatment of pectus excavatum: an alternative to surgical correction?. Eur J Cardiothorac Surg. 2006; 29(4):557-61. DOI: 10.1016/j.ejcts.2006.01.025. View

Adam L, Meehan J . Erosion of the Nuss bar into the internal mammary artery 4 months after minimally invasive repair of pectus excavatum. J Pediatr Surg. 2008; 43(2):394-7. DOI: 10.1016/j.jpedsurg.2007.10.002. View

10.

Gips H, Zaitsev K, Hiss J . Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature. Pediatr Surg Int. 2007; 24(5):617-20. DOI: 10.1007/s00383-007-2097-1. View

11.

Haecker F, Sesia S . Intraoperative use of the vacuum bell for elevating the sternum during the Nuss procedure. J Laparoendosc Adv Surg Tech A. 2012; 22(9):934-6. DOI: 10.1089/lap.2012.0030. View

12.

RAVITCH M . The Operative Treatment of Pectus Excavatum. Ann Surg. 1949; 129(4):429-44. PMC: 1514034. DOI: 10.1097/00000658-194904000-00002. View

13.

Haecker F, Berberich T, Mayr J, Gambazzi F . Near-fatal bleeding after transmyocardial ventricle lesion during removal of the pectus bar after the Nuss procedure. J Thorac Cardiovasc Surg. 2009; 138(5):1240-1. DOI: 10.1016/j.jtcvs.2008.07.027. View

14.

Pilegaard H . Nuss technique in pectus excavatum: a mono-institutional experience. J Thorac Dis. 2015; 7(Suppl 2):S172-6. PMC: 4419029. DOI: 10.3978/j.issn.2072-1439.2015.04.07. View

15.

Kelly Jr R, Mellins R, Shamberger R, Mitchell K, Lawson M, Oldham K . Multicenter study of pectus excavatum, final report: complications, static/exercise pulmonary function, and anatomic outcomes. J Am Coll Surg. 2013; 217(6):1080-9. DOI: 10.1016/j.jamcollsurg.2013.06.019. View

16.

Nuss D, Kelly Jr R, Croitoru D, Katz M . A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998; 33(4):545-52. DOI: 10.1016/s0022-3468(98)90314-1. View

17.

Hosie S, Sitkiewicz T, Petersen C, Gobel P, Schaarschmidt K, Till H . Minimally invasive repair of pectus excavatum--the Nuss procedure. A European multicentre experience. Eur J Pediatr Surg. 2002; 12(4):235-8. DOI: 10.1055/s-2002-34486. View

18.

Barsness K, Bruny J, Janik J, Partrick D . Delayed near-fatal hemorrhage after Nuss bar displacement. J Pediatr Surg. 2005; 40(11):e5-6. DOI: 10.1016/j.jpedsurg.2005.07.038. View

19.

Sacco-Casamassima M, Goldstein S, Gause C, Karim O, Michailidou M, Stewart D . Minimally invasive repair of pectus excavatum: analyzing contemporary practice in 50 ACS NSQIP-pediatric institutions. Pediatr Surg Int. 2015; 31(5):493-9. DOI: 10.1007/s00383-015-3694-z. View

20.

Schier F, Bahr M, Klobe E . The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum. J Pediatr Surg. 2005; 40(3):496-500. DOI: 10.1016/j.jpedsurg.2004.11.033. View