The Vacuum Bell for Treatment of Pectus Excavatum:an Effective Tool for Conservative Therapy

Abstract

Pectus Excavatum (PE) is the most common chest wall malformation and one of the most frequent major congenital anomalies, occurring in approximately 1 in every 300 births (1). In more than 85% of infants, the defect is already noticeable at birth. A later onset may be observed in patients with Marfan syndrome. Until the end of the last century, operations to correct PE deformities were largely based on the technique described by Ravitch (2). In 1998, a new technique of minimally invasive repair of PE (MIRPE) was first described by D. Nuss (3) to avoid several operative features of the modified Ravitch repair procedure. Today, the MIRPE technique is well established and represents a common used technique (4-9). The short operating time, smaller incisions and considerably less dissection has made the MIRPE procedure very appealing both to surgeons and patients, thereby resulting in a large increase of the number of patients requesting operative treatment, and consequently in an increase of the number of PE repairs. However, with the widespread use of the MIRPE procedure the character and number of complications has increased (4, 6-8, 10-12) (Table 1 and 2). Above all, recent studies report on an increasing number of near fatal complications (12-18). Additionally, in many cases of PE, the degree of pectus deformity does not immediately warrant surgery, yet patients may benefit from some type of nonsurgical treatment. Other patients are reluctant to undergo surgery because of the pain associated with postoperative recovery and the risk of imperfect results. Due to these facts, the introduction of the vacuum bell for conservative treatment of PE has made this alternative therapy a focus of interest of patients. The procedure of applying a vacuum to elevate the sternum was first used more than 100 years ago [19]. Despite the risks and unsatisfactory results after operative therapy for some patients, there has been little progress in the therapeutic use of the vacuum therapy during the last few decades. In the meantime, materials have improved and the vacuum devices can now exert strong forces. Our initial results using this method proved to be promising (20). Today, we report our ongoing experience using the vacuum bell for conservative treatment of PE. Note that a subset of these patients (the first 34 patients) was reported previously [20].