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

Aim Pectus Excavatum (PE) is the most common chest wall malformation, and one of the most frequent major congenital anomalies. Surgical repair of PE in childhood is a well-established procedure. Previously used operative techniques to correct PE were largely based on the Ravitch technique. Today, the minimally invasive repair (MIRPE) by Nuss is well established. Conservative treatment with the vacuum bell to elevate the funnel in patients with PE, represents a potential alternative. Material and Methods A suction cup is used to create a vacuum at the anterior chest wall. 3 different sizes of vacuum bell exist which are selected according to the individual patients age. When creating the vacuum, the lift of the sternum is obvious and remains for a different time period. The device should be used for a minimum of 30 minutes (2/day), and may be used up to a maximum of several hours daily. Results 93 patients (77 males, 16 females), aged 3 to 61 years (median 17.8 years) used the vacuum bell for 1 to maximum 24 months. Computed tomographic scans showed that the device lifted the sternum and ribs immediately. In addition, this was confirmed thoracoscopically during the MIRPE procedure. After 18 months in average, the sternum was lifted to a normal level in 9 patients. Relevant side effects were not noted. Conclusions The vacuum bell has proved to be an alternative therapeutic option in selected patients with PE. The initial results proved to be dramatic, but longterm results are so far lacking, and further evaluation and follow-up studies are necessary.