15 years clinical application of the vacuum bell for conservative treatment - lesions we have learned

Abstract

Objective: For decades, open surgical repair was the only available method to treat congenital and acquired Pectus excavatum (PE). Donald Nuss described in 1998 a minimally invasive technique for surgical repair of PE (MIRPE), and today MIRPE is performed with increasing frequency worldwide. However, despite it’s minimally invasive approach, with the widespread use of the MIRPE procedure the character and number of complications have increased. 15-20 years ago, non-surgical measures such as vacuum bell therapy were established as a useful complement to treat PE patients.

Methods: A selective review of the English spoken current literature with focus on vacuum bell therapy was performed, including an analysis of our own studies.

Results: Within the last 5-10 years, an increasing number of studies were identified reporting on conservative treatment of PE using the vacuum bell. There were no randomized and/or prospective studies comparing conservative treatment vs. surgical repair or conservative treatment vs. no specific therapy. Variables predictive of an excellent outcome could be identified. Especially in younger PE patients, conservative treatment is reported with increasing frequency.

Conclusion: The choice of treatment method is mainly dependent on patient’s age at diagnosis and severity of the PE. However, specific treatment is not necessary in every PE patient, but follow-up is important, esp. in pediatric and adolescent patients. Non-surgical treatment seems to represent the first step of specific therapy in the majority of PE patients. Patients and parents may appreciate if the surgeon may offer all treatment modalities.