15 Years of Vacuum Bell Therapy for Pectus Excavatum: Long-term Outcomes and Influencing Factors.

Autor: van Braak H; Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands. Electronic address: h.vanbraak@amsterdamumc.nl., de Beer SA; Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands., Al Ghouch Y; Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands., Zwaveling S; Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands., Oomen MWN; Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands., van Heurn LWE; Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands., de Jong JR; Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Sep 01, pp. 161891. Date of Electronic Publication: 2024 Sep 01.
DOI: 10.1016/j.jpedsurg.2024.161891
Abstrakt: Background: Long-term results and factors affecting outcomes of vacuum bell therapy for pectus excavatum are relatively unknown.
Methods: We conducted a retrospective study on patients (<18y) treated with vacuum bell therapy between May 2008 and October 2021. Primary outcome was treatment success; secondary outcomes were analysis of daily time spent on treatment, treatment duration, complications, long-term follow-up, treatment for patients awaiting a Nuss procedure, treatment for female patients, and factors affecting outcomes.
Results: Of 259 patients treated with vacuum bell therapy, 18.9% (n = 49/259) were still being treated, 17.4% (n = 45/259) were lost to follow-up and 63.7% (n = 165/259) completed treatment, with a 52.1% (n = 86/165) success rate. Median follow-up was 64.0 months (interquartile range 48.0-87.0). More time spent daily on vacuum bell therapy, total treatment duration, and overnight use led to a higher success rate (P = 0.002, P < 0.001, P < 0.001 resp.). Complications (22.8%, n = 59/259) were minor, recurrence occurred in 2.3% (n = 2/86) of patients. Of the patients treated while awaiting a Nuss procedure, 26.7% (n = 4/15) no longer required the Nuss procedure. Breast growth made 39.3% (n = 11/28) of female patients quit treatment. Deeper deformities (P = 0.02, P = 0.009), flexible chest wall (P = 0.007) and symptomatic pectus excavatum (P = 0.02) resulted in lower success rates.
Conclusions: Vacuum bell therapy is successful in up to 52.1% of patients. Overnight vacuum bell use and treatment while awaiting a Nuss procedure should be encouraged. Older patients with a stiff chest wall can be successfully treated with prolonged treatment. For female patients watchful waiting or early treatment, to prevent challenges during breast growth, is preferred.
Level of Evidence: Level II.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: