Preliminary application of negative pressure suction bell in young children with pectus excavatum_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FU Jian , WU Chun , LI Yonggang , LI Hongbo , WANG Gang , DAI Jiangtao ,  PAN Zhengxia

Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, P. R. China;

Corresponding author：

PAN Zhengxia, Email: 285106764@qq.com

Keywords：

Young children; pectus excavatum; negative pressure suction bell

DOI：

10.7507/1007-4848.202308013

Video：

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Objective To summarize and analyze the clinical efficacy of negative pressure suction bell in the treatment of young children (≤6 years) with pectus excavatum. Methods The relevant clinical medical records of the children with pectus excavatum who received negative pressure suction bell treatment in the Outpatient Department of Children’s Hospital of Chongqing Medical University from May 2019 to January 2023 were collected. The age, sex, type, severity, depth of depression, duration of use and prognosis of children with pectus excavatum were retrospectively analyzed. Results A total of 100 pediatric patients were ultimately included in the study, comprising 74 males and 26 females. The age distribution was 57 patients aged 0-3 years and 43 patients aged 3-6 years. All patients were prescribed and used a negative pressure suction device for at least 3 months, after which they returned to our department's outpatient clinic for follow-up. The treatment demonstrated clinical effectiveness in 99 patients, yielding an efficacy rate of 99.00%. The excellent/good rate was 52.00%, and the complication rate was 8.00%. After treatment, the Haller index and the depth of sternal depression were reduced compared with those before treatment (P<0.001), and there was no statistical difference in the effective rate and excellent/good rate between different genders, different ages, different types of pectus excavatum, or different severity (P＞0.05). Conclusion Negative pressure suction bell is safe and effective in the treatment of young children (≤6 years) with pectus excavatum, and the correction effect has nothing to do with gender, type and severity .

1.	Fibla JJ, Molins L. Minimally invasive treatment of pectus excavatum. Minerva Chir, 2016, 71(1): 38-45.
2.	Cramm SL, Luckhurst C, Galls A, et al. Thoracic epidural-based Enhanced Recovery After Surgery (ERAS) pathway for Nuss repair of pectus excavatum shortened length of stay and decreased rescue intravenous opiate use. Pediatr Surg Int, 2021, 37(9): 1191-1199.
3.	Gräfe D, Lacher M, Martynov I, et al. Pectus excavatum in motion: dynamic evaluation using real-time MRI. Eur Radiol, 2023, 33(3): 2128-2135.
4.	Shi R, Xie L, Chen G, et al. Surgical management of pectus excavatum in China: results of a survey amongst members of the Chinese Association of Thoracic Surgeons. Ann Transl Med, 2019, 7(9): 202.
5.	Dzielicki J, Korlacki W, Janicka I, et al. Difficulties and limitations in minimally invasive repair of pectus excavatum: 6 years experiences with Nuss technique. Eur J Cardiothorac Surg, 2006, 30(5): 801-804.
6.	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.
7.	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(6): 1221-1225.
8.	St-Louis E, Miao J, Emil S, et al. Vacuum bell treatment of pectus excavatum: an early North American experience. J Pediatr Surg, 2019, 54(1): 194-199.
9.	Gao Y, Li JH, Yu JG, 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.
10.	董星铄. 应用客制负压吸盘无创治疗儿童漏斗胸的效果评价的单中心研究. 中国医科大学, 2022.Dong XS. Single-center study on the effectiveness of the non-invasivetreatment of children's pectus excavatum with customizednegative pressure vacuum bell. China Medical University, 2022.
11.	陈晓迪. 个性化定制负压吸盘对婴幼儿漏斗胸的治疗效果. 中国医科大学, 2021.Chen XD. The effect of personalized negative pressure suction cup on infantile pectus excavatu. China Medical University, 2021.
12.	Nuss D, Kelly RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
13.	Matsuo N, Matsumoto K, Taura Y, et al. Initial experience with a 3D printed model for preoperative simulation of the Nuss procedure for pectus excavatum. J Thorac Dis, 2018, 10(2): E120-E124.
14.	Loufopoulos I, Karagiannidis IG, Lampridis S, et al. Vacuum bell: is it a useful innovative device for pectus excavatum correction? Turk Thorac J, 2021, 22(3): 251-256.
15.	Sesia SB, Hradetzky D, Haecker FM. Monitoring the effectiveness of the vacuum bell during pectus excavatum treatment: technical innovation. J Pediatr Surg, 2018, 53(3): 411-417.
16.	Haecker FM, Sesia S. Non-surgical treatment of pectus excavatum. J Vis Surg, 2016, 2: 63.
17.	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(1): 183-187.
18.	Luo D, Cheng K, Yuan M, et al. Efficacy and determinants of vacuum bell treatment in preschool children with pectus excavatum. Front Pediatr, 2022, 10: 1008437.

1. Fibla JJ, Molins L. Minimally invasive treatment of pectus excavatum. Minerva Chir, 2016, 71(1): 38-45.
2. Cramm SL, Luckhurst C, Galls A, et al. Thoracic epidural-based Enhanced Recovery After Surgery (ERAS) pathway for Nuss repair of pectus excavatum shortened length of stay and decreased rescue intravenous opiate use. Pediatr Surg Int, 2021, 37(9): 1191-1199.
3. Gräfe D, Lacher M, Martynov I, et al. Pectus excavatum in motion: dynamic evaluation using real-time MRI. Eur Radiol, 2023, 33(3): 2128-2135.
4. Shi R, Xie L, Chen G, et al. Surgical management of pectus excavatum in China: results of a survey amongst members of the Chinese Association of Thoracic Surgeons. Ann Transl Med, 2019, 7(9): 202.
5. Dzielicki J, Korlacki W, Janicka I, et al. Difficulties and limitations in minimally invasive repair of pectus excavatum: 6 years experiences with Nuss technique. Eur J Cardiothorac Surg, 2006, 30(5): 801-804.
6. 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.
7. 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(6): 1221-1225.
8. St-Louis E, Miao J, Emil S, et al. Vacuum bell treatment of pectus excavatum: an early North American experience. J Pediatr Surg, 2019, 54(1): 194-199.
9. Gao Y, Li JH, Yu JG, 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.
10. 董星铄. 应用客制负压吸盘无创治疗儿童漏斗胸的效果评价的单中心研究. 中国医科大学, 2022.Dong XS. Single-center study on the effectiveness of the non-invasivetreatment of children's pectus excavatum with customizednegative pressure vacuum bell. China Medical University, 2022.
11. 陈晓迪. 个性化定制负压吸盘对婴幼儿漏斗胸的治疗效果. 中国医科大学, 2021.Chen XD. The effect of personalized negative pressure suction cup on infantile pectus excavatu. China Medical University, 2021.
12. Nuss D, Kelly RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
13. Matsuo N, Matsumoto K, Taura Y, et al. Initial experience with a 3D printed model for preoperative simulation of the Nuss procedure for pectus excavatum. J Thorac Dis, 2018, 10(2): E120-E124.
14. Loufopoulos I, Karagiannidis IG, Lampridis S, et al. Vacuum bell: is it a useful innovative device for pectus excavatum correction? Turk Thorac J, 2021, 22(3): 251-256.
15. Sesia SB, Hradetzky D, Haecker FM. Monitoring the effectiveness of the vacuum bell during pectus excavatum treatment: technical innovation. J Pediatr Surg, 2018, 53(3): 411-417.
16. Haecker FM, Sesia S. Non-surgical treatment of pectus excavatum. J Vis Surg, 2016, 2: 63.
17. 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(1): 183-187.
18. Luo D, Cheng K, Yuan M, et al. Efficacy and determinants of vacuum bell treatment in preschool children with pectus excavatum. Front Pediatr, 2022, 10: 1008437.

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