Pediatric Chest Wall Surgery Enhances Safety, Reduces Post-Op Pain

Pediatric chest wall disorders sometimes cause physiological symptoms. For example, pectus excavatum may lead to shortness of breath, chest pain or exercise intolerance due to compression of the heart and lungs. Beyond that, the psychosocial impact of feeling self-conscious about their appearance is debilitating for some children and teens.

The Chest Wall Program at Lehigh Valley Reilly Children’s Hospital provides comprehensive evaluation and treatment for such conditions, including:

• Pectus excavatum, a chest that curves inward
• Pectus carinatum, a chest that curves outward
• Poland syndrome, missing or underdeveloped chest muscles

Both nonsurgical and surgical treatments are offered. One leading-edge surgical option is video-assisted pectus excavatum repair (VAPER) using an approach that optimizes patient safety.

For select individuals with pectus excavatum, vacuum bell therapy, a nonsurgical method of lifting the chest wall, can be beneficial. When surgery is required, VAPER is the linchpin of treatment.

“This surgery is a tour de force,” says Sarah Sapienza, MD, a pediatric surgeon and director of the Chest Wall Program. “At Lehigh Valley Reilly Children’s Hospital, we have taken extra steps to ensure that we are performing the safest possible version of pectus excavatum repair.”

Along with Dr. Sapienza, other pediatric surgeons who are part of the Children’s Hospital’s VAPER team include Daniel Relles, MD, and Marybeth Browne, MD

VAPER involves implanting a bar that lifts the chest into a normal position. Prior to surgery, CT images are used to custom-bend a bar for the individual.

At Lehigh Valley Reilly Children’s Hospital, this procedure is performed by two surgeons operating in tandem. An incision is made on each side of the chest: one through which the surgeons insert a camera to visualize the heart, great vessels and lungs, and another through which they insert the bar and fix it to the chest wall. Sternal clamping provides added space for the bar to pass in front of the heart.

“With double visualization, we never lose sight of the bar as it crosses from one side of the chest to the other, which is crucial for safety,” Dr. Sapienza says

A key innovation is the use of intraoperative cryoablation to temporarily freeze the intercostal nerves.

This has transformed what would otherwise be quite a painful recovery into one that is manageable, reducing the need for narcotic medication.

“After surgery, patients have a chest wall that is imperceptibly different from their peers,” Dr. Sapienza says. “That can make a big difference in their lives.”