Assessing the probability of success with vacuum bell therapy in pediatric patients with pectus excavatum: a systematic review and future directions.

Nonsurgical interventions typically emphasize patients safety, minimum complications, and cost effectiveness compared to surgical procedures. The aim of this study was to conduct a systematic review to evaluate the efficacy of vacuum bell therapy as a nonsurgical option for managing pectus excavatum in pediatric patients. Vacuum bell therapy. A systematic review adhering to PRISMA guidelines was conducted, we searched four electronic databases (PubMed, Scopus, and Web of Science) up to August 15, 2024. The search focused on PE and vacuum therapy. Inclusion criteria targeted pediatric patients, while unsuitable studies were excluded. The JBI Critical Appraisal Checklist, New Castle Ottawa scale assessment and Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2) were utilized to assess risk of bias. Twenty studies met the criteria. Risk of bias was low in two, moderate in thirteen, and high in five studies. VB therapy duration varied from 30 min to several hours daily. Factors influencing outcomes included age, chest wall flexibility, PE severity, VB duration, and symmetry. The most common correction pattern was poor > fair > good > excellent, with good results observed as early as six months. Complications were mild and temporary, not requiring medication. VB therapy shows significant improvement in preteens with mild PE. Efficacy depends on age, chest flexibility, severity, and therapy duration. The lack of randomized controlled trials limits the strength of the evidence. The effectiveness of vacuum bell therapy in failed surgeries or in preventing injuries during procedures like the Nuss, needs further investigation, and if no visible results are seen after 6 to 12 months, surgery should be considered.