Failed preoperative vacuum bell therapy does not affect outcomes following minimally invasive repair of pectus excavatum

Abstract

Purpose It is unknown if failed preoperative vacuum bell (VB) treatment in patients undergoing minimally invasive repair of pectus excavatum (MIRPE), delays repair and/or affects postoperative outcomes. Methods A retrospective data analysis including all consecutive patients treated at one single institution undergoing MIRPE was performed between 2000 and 2016. Patients were stratified into preoperative VB therapy versus no previous VB therapy. Results In total, 127 patients were included. Twenty-seven (21.3%) patients had preoperative VB treatment for 17 months (median, IQR 8–34). All 27 patients stopped VB treatment due to the lack of treatment effect. Eight (47.1%) of 17 assessed VB patients showed signs of skin irritation or hematoma. VB treatment had no effect on length of hospital stay (p = 0.385), postoperative complications (p = 1.0), bar dislocations (p = 1.0), and duration of bar treatment (p = 0.174). Time spent in intensive care unit was shorter in patients with VB therapy (p = 0.007). Long-term perception of treatment including rating of primary operation (p = 0.113), pain during primary operation (p = 0.838), own perspective of look of chest (p = 0.545), satisfaction with the procedure (p = 0.409), and intention of doing surgery again (p = 1.0) were not different between groups. Conclusions Failed preoperative VB therapy had no or minimal effect on short-term outcomes and long-term perceptions following MIRPE.

Treatment with pectus excavatum with vacuum bell during puberty

“…The VB is said to be useful while the patient is waiting for surgical treatment, since it will somehow facilitate surgery. However, no impact on short-term results or long-term perceptions following surgery has been noted in those cases previously treated with VB (6,9,20) . The bell should not be regarded as a substitute for surgery (Nuss procedure), which allows for complete repair in all PE types and is the treatment of choice in severe cases (5,9) .…”

Tratamiento del pectus excavatum con campana de succión durante la pubertad

“…Se afirma que la CS puede ser útil mientras el paciente espera al tratamiento quirúrgico, pues de algún modo facilitaría la intervención, pero no se han observado efectos en los resultados a corto plazo ni en las percepciones a largo plazo tras cirugía en los casos tratados previamente con la CS (6,9,20) . La campana no puede considerarse un sustituto de la cirugía (procedimiento de Nuss), que logra una corrección completa en todo tipo de PE y es el tratamiento de elección en casos severos (5,9) .…”