Advancing pectus deformity care: evaluation of current treatments, complications and future innovations

Braak, H. van (2026)

Doctoral Thesis

This thesis evaluates current treatments, complications, and future innovations in the management of pectus deformities, focusing primarily on pectus carinatum and pectus excavatum. It demonstrates that dynamic compression system (DCS) bracing is an effective first-line, non-invasive treatment for pectus carinatum, improving quality of life, self-esteem, and physical symptoms, while surgical correction provides higher success rates but with greater complication risks. For pectus excavatum, outcomes of vacuum bell therapy and the Nuss procedure are examined, highlighting the importance of treatment duration and patient motivation for vacuum bell therapy, and optimized postoperative pain management, particularly the advantages of intercostal nerve cryoablation over epidural analgesia, for the Nuss procedure. The thesis also addresses postoperative complications such as pleural effusion, infection, and allergic reactions, proposing diagnostic and management strategies. Cross-cutting analyses reveal that prolonged surgical waiting times influence treatment decisions, with many adolescents declining surgery due to psychosocial development and improved body acceptance. Overall, the work supports individualized, minimally invasive, and patient-centered approaches while identifying opportunities for objective outcome measurement, complication reduction, and innovation in pectus deformity care.

• Pectus deformities
• Pectus carinatum
• Pectus excavatum
• Dynamic compression bracing
• Nuss procedure
• Vacuum bell therapy
• Quality of life
• Postoperative complications
• Pain management
• Treatment decision-making

• All authors: Braak, H. van
• Supervisor: Heurn, L.W.E. van
• Co-supervisor: Jong, J.R. de
• Committee: Bouvy, N.D.; Haecker, F.M.; Derikx, J.P.M.; Schipper, I.B.; Loos, E.R. de
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2026-03-11
• ISBN (print): 9789465065830
• DOI: doi:10.60602/1887-4296544