Authors (including presenting author) :
Lee KFL (1), Fong S (2), Chan L (2), Yam N (1)
Affiliation :
(1) Paediatric Cardiothoracic Surgery, Hong Kong Children's Hospital
(2) Occupational Therapy, Integrated Rehabilitation Centre, Hong Kong Children's Hospital
Introduction :
Pectus excavatum, or "funnel chest", is the commonest chest wall deformity which carries both physiological and psychological impact to patients. Despite the encouraging results from operative treatment, non-invasive intervention becomes increasingly popular internationally because of the favourable outcome and devoid of surgical risks. Vacuum bell therapy is a novel concept using a device to correct the sternal depression by negative suction force. Participants are required to use the device at least 2-4 hours a day for 12-18 months, and hence compliance with treatment protocol serves as the key to success. Those who are not satisfied with the result can still opt for definitive surgery afterwards. Since 2021, this device has been introduced to the Hong Kong Children's Hospital and the service is jointly offered by occupational therapists and paediatric cardiothoracic surgeons.
Objectives :
To evaluate the efficacy of vacuum bell therapy, in the setting of combined surgical and allied health clinic, in adolescent patient with pectus excavatum.
Methodology :
This is a prospective pilot study. Consecutive patients who were referred for vacuum bell therapy were recruited. Interval evaluation, adjustment of device setting, and compliance check were performed in the joint clinic and via tele-follow up due to the COVID-19 pandemic. Outcome measures included the pre- and post-treatment chest wall depth, percentage of correction, and incidence of adverse events.
Result & Outcome :
Until December 2022, total 20 adolescents (mean age 13.5±1.53) received the service. 2 patients dropped out due to personal reasons within the first month of treatment. Among the remaining 18 patients, the median Haller index and chest wall depth was 3.52 (IQR [3.26 – 4.43]) and 2.1cm (IQR [1.5 – 2.7]) respectively. After a median treatment period of 8 months (IQR [6-12]), improvement was observed in 10 patients (55.6%). 4 patients (22.2%) had ≥50% correction. No serious adverse events were reported.
Vacuum bell therapy is a safe non-invasive alternative treatment for pectus excavatum. Effective service provision was ensured using telehealth technology. Although complete study result is pending, apparent improvement of the deformity is observed which may spare our paediatric patients from invasive surgical intervention.
