Is vacuum bell therapy effective in the correction of pectus excavatum?

A best evidence topic in thoracic surgery was written in accordance to a structured protocol. The question addressed was: 'In patients with a pectus excavatum deformity, is vacuum bell therapy (VBT) an effective treatment?' Altogether, 19 papers were found using the reported search of which 7 represented the best evidence to answer the clinical questions. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Numerous groups have demonstrated the utility of VBT in pectus excavatum; the largest series has followed up patients over 13 years with sternal elevation of >1 cm being demonstrated in 105 patients. Initial age <11, initial chest wall depth <1.5 cm and chest wall flexibility have all been associated with better outcomes. The effects of VBT have been confirmed on computed tomography scanning and intraoperatively to lift the sternum to facilitate retrosternal soft tissue dissection during the Nuss procedure. There was significant heterogeneity in the studies reviewed, in terms of patient age, selection criteria, the VBT protocol, length of follow-up time following completion of VBT and the metrics used to assess success of therapy. VBT is a safe therapy for treating pectus excavatum in a non-surgical conservative manner with few complications reported. However, the success of VBT is largely dependent on patient compliance and motivation. Permanence of correction after completion of VBT needs to be properly assessed through rigorous follow-up, and currently the success of correction, i.e. permanence, remains in the hands of the patient.