Treatment of pectus excavatum in children with the vacuum bell: a literature review

Abstract

Pectus excavatum is the most common type of chest deformation with the sunken sternum and adjacent parts of the ribs. In recent decades, approach to the management of this pathology has changed, in many respects due to Eckhart Kloba’s invention a vacuum bell in 1992, which can be used both intraoperatively and as a non-invasive monotherapy. Literary sources were searched in PubMed, Web of Science, Scopus, Google Scholar, and Elibrary databases. The following keywords were used for search in the English literature: «pectus excavatum», «funnel chest», «vacuum bell», «vacuum chest wall lifter», «suction cup», «minimally invasive repair of pectus excavatum (MIRPE)», «intraoperative vacuum bell». In Russian-language literature sources, the key words were: “воронкообразная деформация грудной клетки», «консервативное лечение», «вакуумный колокол». More than 50 publications on this topic have been analyzed. Patients of different age groups with pectus excavatum of varying severity were taken in the study. The effectiveness of treatment was mainly assessed by computed tomography measurements of deformity depth and the Haller index before and after treatment. Excellent correction results were achieved in 13.5–80% of patients with the vacuum bell. The authors have made an attempt to define how patient’s age, duration of treatment, pathology severity, and deformity type correlate with the effectiveness of vacuum bell treatment. The vacuum bell can also be used as a non-invasive lift of the sternum during Nuss thoracoplasty surgery. Currently, there is no any unified tactics for the conservative management of patients with pectus excavatum, namely, unified indications, period of conservative treatment, and optimal patient’s age for vacuum bell application. In the available literature, there is no any criterion that could predict the success of conservative treatment; there are no follow-up data for more than 2 years. A more precise assessment of vacuum bell effectiveness in the treatment of patients with pectus excavatum should be confirmed in longer studies with a larger number of cases.