Dr hab. med. Marek Orkiszewski
specialist paediatric surgeon
During my nearly 50-year-work as a surgeon I have operated on many patients with pectus excavatum.The first treatment ever used was the Ravitch procedure (1949), which consisted of a wide multiple rib resection. It was soon supplemented by other surgeons with a metal bar supporting the floating sternum from below.
Professor Donald Nuss (1987) decided not to remove the deformed ribs but simply to relocate them to their normal anatomical position with a metal plate without opening the chest. It was a real breakthrough in surgery. In this way he managed to preserve the deformed ribs without extensive opening the chest. His method was a true eye-opener to many surgeons - the medical knowledge and the equipment used by Professor Nuss had been known and available for a long time but Professor Nuss applied them for the first time to safely fix bones without causing extensive damage to the chest integrity and its function.
However, I had some surgical doubts about this procedure. In 2009 I went to Norfolk ( USA) to train under the guidance of Professor Nuss. It is hard to believe but so far I have been the only Polish surgeon to train under Professor Nuss since he had reported on his first pectus excavatum patient in 1987. During my stay in Norfolk I assisted Professor Nuss during an operation n which he used the Klobe vacuum bell for the first time .
Prof. Donald Nuss is a great surgeon and a real gentleman. I will long remember his hospitable home and his welcoming wife, a great fan of Agnieszka Radwańska.
In 2004 during my visit in Jena I learned more about non-operative treatment of pectus excavatum by means of a vacuum bell designed by engineer Eckard Klobe. Professor Felix Schier invited me then to join his team to implement a silicone cusp to elevate the depressed sternum by gradually applying vacuum and thus moving the sternum and adjoining chondral parts of the ribs upwards.
During the following years my team consisting of a paediatric surgeon, physiotherapist and orthopaedic technicians have treated nearly 400 patients with chest deformities. In addition to developing nonoperative treatment techniques of pectus excavatum, I actively assisted Professor Klaus Schaarschmidt in Berlin in the operating room. Professor Klaus Schaarschmidt, is a great surgeon full of respect for other surgeons, one of the few who represent the old good school of surgeons.
It was some time later that I learned how to fix pectus carinatum. The method of Dr Sidney Haje from Brasil was already well known worldwide in 2000's . Unfortunately, Dr Haje died unexpectedly before I arrived in Brasil in 2012.
In our practice we have adopted a bracing strategy from Canada gradually improving it and adjusting to our patients. Recently in our relentless pursuit of excellence we have entirely changed the strategy of treatment, the bracing system and preparatory management before bracing. We are happy to say that our now nearly constant excellent results are the goal we have long been striving for.
Training in spirometry assessment was a large asset into our education.
We believe that each patient with pectus excavatum should first undergo a trial of conservative treatment with intensive physiotherapy programme and a course of mobilisation of the depressed part of the chest. This would largely shorten the recovery period and improve the surgical effects resulting in an improved posture.
The first choice treatment of pectus carinatum consists in nonoperative treatment, surgery being limited to a very small group of deformities.
Mgr Michał Orkiszewski
During the recent 4 years I have attended to nearly 400 new patients with pectus excavatum (funnel chest) and pectus carinatum (pigeon chest). I managed to develop a customised programme for patients aged several months to over 18 years. Since 2006 we have been using a suction devise developed by Eckhart Klobe to elevate the depressed sternum in pectus excavatum. Only a few medical centres in the world can offer this treatment. "Treatment of pectus excavatum patients by means of the Klobe vacuum bell" was my bachelor's thesis defended in 2015 (University of Medical Sciences in Poznań, Poland). A surgical centre from the University of Basel has recently expressed interest in cooperation.
Pectus carinatum patients have been treated by a non-operative bracing system developed in cooperation with American colleagues. In nearly 95% patients with pigeon chest the results are excellent. Only a minor proportion with an upper horse-shoe deformity appear not repairable with bracing, and a surgical repair is then recommended.