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Non-surgical treatment of pectus excavatum in children


Authors: B. Špaková 1;  M. Molnár 1;  M. Gura 1;  F. Olekšák 2;  D. Murgaš 1;  M. Dragula 1
Authors‘ workplace: Klinika detskej chirurgie, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Univerzitná nemocnica Martin, Slovensko 1;  Klinika detí a dorastu, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Univerzitná nemocnica Martin, Slovensko 2
Published in: Čes-slov Pediat 2021; 76 (7): 392-399.
Category: Review

Overview

Pectus excavatum is the most common type of chest deformity. It is usually asymptomatic, but patients suffering from severe forms may experience increased fatigue, exercise dyspnoea, chest pain, palpitations and/or decreased tolerance to physical activity. Psychological difficulties associated with this diagnosis stem from patients' perceiving the deformity as a disability and causing them to avoid activities with an exposed chest (e. g. swimming).

For a long time, the only available type of treatment was a surgical correction. An important part of the therapy is rehabilitation aimed at correcting the body posture by strengthening chest and back muscles as well as breathing exercises. In the last 15 years there has been an increase in the use of a conservative treatment using the vacuum bell. Although conclusive results based on long-term supporting evidence are lacking, the disponible studies demonstrate vacuum bell treatment is a safe option for pectus excavatum with minimal complications.

Keywords:

Physiotherapy – rehabilitation – conservative treatment – pectus excavatum – vacuum bell


Sources

1. Fokin AA, et al. Anatomical, histologic and genetic characteristics of congenital chest deformities. Semin Thorac Cardiovasc Surg 2009; 21 (1): 44–57.

2. Jaroszewski D, et al. Current management of pectus excavatum: A review and update of therapy and treatment recommendations. J Am Board Fam Med 2010; 23: 230–239.

3. Koumbourlis AC, Stolar CJ. Lung growth and function in children and adolescents with idiopathic pectus excavatum. Pediatr Pulmonol 2004; 38: 339–343.

4. Fonkalsrud EW. Current management of pectus excavatum. World J Surg 2003; 27: 502–508.

5. Malek MH, Fonkalsrud EW, Cooper CB. Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest 2003; 124: 870–882.

6. Kelly RE, et al. Multicenter study of pectus excavatum, final report: Complications, static/exercise pulmonary function, and anatomic outcomes. J Am Coll Surg 2013; 217 (6): 1080–1089.

7. Kelly RE, Shamberger RC, Mellins R, et al. Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg 2007; 205 (2): 205–216.

8. Canavan PK, Cahalin L. Integrated physical therapy intervention for a person with pectus excavatum and bilateral shoulder pain: a single-case study. Arch Phys Med Rehabil 2008; 89: 2195–2204.

9. Ravitch MM. The operative treatment of pectus excavatum. Ann Surg 1949, 129: 429–444.

10. Molnár M. Vrodené deformity hrudníka. In: Dragula M, et al. Detská chirurgia. Turany: Vydavateľstvo P+M, 2015: 498–508.

11. Nuss D. A 10 year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998; 33 (4): 545–552.

12. Molnár M. Vrodené deformity hrudníka. In: Dragula M. Moderné trendy v detských chirurgických oboroch. 2. diel. Librex, 2019: 20–26.

13. Haecker FM, Mayr J. The vacuum bell for treatment of pectus excavatum: an alternative to surgical correction? Eur J Cardiothorac Surg 2006; 29: 557–561.

14. Torre M, Rapuzzi G, Jasonni V, Varela P. Chest wall deformities: an overview on classification and surgical options. In: Cardoso P. Topics in Thoracic Surgery. Rijeka: InTech 2012, 8: 117–136. ISBN: 978-953-51-6796-9.

15. Milanez Ribas de Campos J, De Miranda Luzo MC. Which orthosis and physiotherapy before and after surgery. Pectus press. In:1st International Chest Wall Course. Lucca, 2019.

16. Culham EG, Jimenez HA, King CE. Thoracic kyphosis, rib mobility and lung volumes in normal women and women with osteoporosis. Spine 1994; 19: 1250–1255.

17. Behrakis PK, Baydur A, Jaeger MJ, Milic-Emili J. Lung mechanics in sitting and horizontal body positions. Chest 1983; 83: 643–646.

18. Cheung SY. Exercise therapy in the correction of pectus excavatum. J Pediatr Respir Crit Care 2005; 1: 10–13.

19. Alaca N, Alaca I, Yuksel M. Physiotherapy in addition to vacuum bell therapy in patients with pectus excavatum. Interact Cardiovasc Thorac Surg 2020, 1–7.

20. Rigo M, Reiter CH, Weiss H. Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil 2003; 6: 209–214.

21. Maruyama T, Kitagawa T, Takeshita K, et al. Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment? Pediatr Rehabil 2003; 6: 215–219.

22. Bayar B, Uygur F, Bayar K, et al. The short term effects of an exercise programme as an adjunct to an orthosis in neuromuscular scoliosis. Prosthet Orthot Int 2004; 28 (3): 273–277.

23. Lange F. Thoraxdeformitäten. In: Schlossmann A, Pfaundler M. Handbuch der Kinderheilkunde. Leipzig: FCW Vogel, 1910, 5: 157.

24. 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.

25. Haecker FM, Sesia S. Non-surgical treatment of pectus excavatum. J Vis Surg 2016; 2: 63.

26. Gao Y, et al. Noninvasive treatment of pectus excavatum with a vacuum bell combined with a three-dimensional scanner. Pediatr Surg Int 2020; 36 (10): 1205–1211.

27. Haecker FM, Zuppinger J, Sesia S. Le traitement conservateur du thorax en entonnoir par cloche à aspiration. Forum Med Swiss 2014; 14: 842–849.

28. Lopez M, Patoir A, Costes F, et al. Preliminary study of efficacy of cup suction in the correction of typical pectus excavatum. J Pediatr Surg 2016; 51: 183–187.

29. Obermeyer RJ, Cohen NS, Kelly RE, et al. Nonoperative management of pectus excavatum with vacuum bell therapy: a single center study. J Pediatr Surg 2018; 53: 1221–1225.

30. St-Louis E, et al. Vacuum bell treatment of pectus excavatum: An early North American experience. J Pediatr Surg 2019; 54: 194–199.

31. Togoro SY, Tedde ML, Eisinger RS, et al. The Vacuum Bell device as a sternal lifter: an immediate effect even with a short time use. J Pediatr Surg 2018; 53: 406–410.

32. Haecker FM, Sesia SB. Intraoperative use of the vacuum bell for elevating the sternum during the Nuss procedure. J Laparoendosc Adv Surg Tech A 2012; 22: 934–936.

33. Patel AJ, Hunt I. Is vacuum bell therapy effective in the correction of pectus excavatum? Interact Cardiovasc Thorac Surg 2019; 29: 287–290.

34. Haecker FM, Sesia S. Vacuum bell therapy. Ann Cardiothorac Surg 2016; 5 (5): 440–449.

35. Nuss D, et al. Pectus excavatum from a pediatric surgeon’s perspective. Ann Cardiothorac Surg 2016; 5 (5): 493–500.

Labels
Neonatology Paediatrics General practitioner for children and adolescents
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