{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:42:03Z","timestamp":1786650123578,"version":"build-2736575974"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To systematically review and synthesize available evidence on the efficacy, safety, and clinical outcomes of VB therapy in patients with PE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twenty-seven studies comprising 2644 patients (predominantly male, aged 3\u201320 years) were included. Definitions of treatment success varied, with excellent correction reported in 11%\u201352.5% of cases and overall improvement (excellent + good) ranging from 60% to 80% across studies. Predictors of better outcomes included younger age (&lt;10 years), shallow and symmetric deformity, and high adherence (&gt;28 h\/week or \u226512 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jiaps.jiaps_274_25","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T11:00:30Z","timestamp":1767956430000},"page":"4-19","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Vacuum Bell Therapy in Pectus Excavatum: A Systematic Review of Clinical Outcomes"],"prefix":"10.4103","volume":"31","author":[{"given":"Bitesh","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishesh","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devendra Kumar","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabudh","family":"Goel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Post Graduate Institute of Child Health, Noida, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjan Kumar","family":"Dhua","sequence":"additional","affiliation":[{"name":"Department of Pediatric 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correction?","volume":"22","author":"Loufopoulos","year":"2021","journal-title":"Turk Thorac J"},{"key":"R6-20260420","first-page":"22","article-title":"Pectus excavatum treatment with the eckart klobe vacuum bell","volume":"1","author":"Klobe","year":"2019","journal-title":"Orthop Tech"},{"key":"R7-20260420","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s00383-010-2843-7","article-title":"The vacuum bell for conservative treatment of pectus excavatum: The Basle experience","volume":"27","author":"Haecker","year":"2011","journal-title":"Pediatr Surg Int"},{"key":"R8-20260420","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1093\/icvts\/ivz082","article-title":"Is vacuum bell therapy effective in the correction of pectus excavatum?","volume":"29","author":"Patel","year":"2019","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"R9-20260420","doi-asserted-by":"crossref","first-page":"ezae166","DOI":"10.1093\/ejcts\/ezae166","article-title":"The pectus care guidelines: Best practice consensus guidelines from the joint specialist societies SCTS\/MF\/CWIG\/BOA\/BAPS for the treatment of patients with pectus abnormalities","volume":"66","author":"Dunning","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"R10-20260420","doi-asserted-by":"crossref","first-page":"5285","DOI":"10.21037\/jtd-23-408","article-title":"20 years clinical application of the vacuum bell for conservative treatment of pectus excavatum-past, present, future","volume":"16","author":"Haecker","year":"2024","journal-title":"J Thorac Dis"},{"key":"R11-20260420","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jpedsurg.2024.161891","article-title":"15 years of vacuum bell therapy for pectus excavatum: Long-term outcomes and influencing factors","volume":"60","author":"van Braak","year":"2025","journal-title":"J Pediatr 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of vacuum bell therapy for pectus excavatum: Compliance is key","volume":"308","author":"Koo","year":"2025","journal-title":"J Surg Res"},{"key":"R35-20260420","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1186\/s12887-024-04615-3","article-title":"Vacuum bell therapy for pectus excavatum: A retrospective study","volume":"24","author":"Lei","year":"2024","journal-title":"BMC Pediatr"},{"key":"R36-20260420","doi-asserted-by":"crossref","first-page":"1467215","DOI":"10.3389\/fped.2024.1467215","article-title":"Questionnaire-based subjective evaluation and analysis of factors influencing the effectiveness of treatment with the vacuum bell in children with pectus excavatum: A cross-sectional observational study","volume":"12","author":"Zhou","year":"2024","journal-title":"Front Pediatr"},{"key":"R37-20260420","doi-asserted-by":"crossref","first-page":"162020","DOI":"10.1016\/j.jpedsurg.2024.162020","article-title":"Vacuum bell therapy for pectus excavatum: Long-term experience at a single center","volume":"60","author":"Aughtman","year":"2025","journal-title":"J Pediatr Surg"}],"container-title":["Journal of Indian Association of Pediatric 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History"}},{"value":"2025-10-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}