Efficacy and Safety of Vacuum Bell Therapy in Pectus Excavatum: A Systematic Review of Clinical Outcomes

Introduction: Pectus excavatum (PE) is the most common congenital chest wall deformity. The vacuum bell (VB) is a noninvasive alternative to surgical correction, increasingly used in pediatric and adolescent patients. However, evidence on its efficacy, safety, and predictors of success remains fragmented. Objective: To systematically review and synthesize available evidence on the efficacy, safety, and clinical outcomes of VB therapy in patients with PE. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Searches of PubMed, Embase, and Web of Science were performed up to July 15, 2025. Studies reporting clinical outcomes of VB therapy were included. Extracted data included patient demographics, treatment protocols, efficacy measures (sternal elevation, Haller Index reduction, and correction rates), safety outcomes (adverse events), and predictors of success. Risk of bias was assessed using standardized tools appropriate for each study design. Results: Twenty-seven studies comprising 2644 patients (predominantly male, aged 3–20 years) were included. Definitions of treatment success varied, with excellent correction reported in 11%–52.5% of cases and overall improvement (excellent + good) ranging from 60% to 80% across studies. Predictors of better outcomes included younger age (<10 years), shallow and symmetric deformity, and high adherence (>28 h/week or ≥12 months of therapy). Adverse events were infrequent and mild, including skin irritation and transient discomfort. Patient satisfaction was reported in 18 studies, while functional or psychosocial improvement was documented in 10. Conclusion: Vacuum bell therapy is safe and effective for selected patients with mild-to-moderate PE, especially when initiated early and used consistently. Standardized treatment protocols and longer follow-up studies are required to refine patient selection and optimize outcomes.