Overview

Vacuum bell therapy is a technique, first developed in 2005, used to treat pectus excavatum non-surgically. The vacuum bell is a cup-shaped device made of soft rubber that’s connected to a hand pump. The device is placed on the chest of the pectus patient and the pump is used to suck the air out of the device. This creates suction, or a vacuum, that pulls the chest and breastbone forward. With consistent use, the breastbone and ribs stay forward on their own [6]. A vacuum bell comes in a variety of sizes (16, 19 and 26 cm in diameter) and shapes, including vacuum bells for women and girls [1] [3].

The vaccum bell is placed above the breastbone.

Vaccum bells are made in varying sizes and shapes.

How does it work?

Opinions on how long and how often the vacuum bell should be used can vary between doctors and studies, but most agree on a minimum use of 30 minutes twice a day [5]. There are five steps to operate a vacuum bell

device. Children under 10 normally need help from a caregiver to use the device [6].

Place the device on top of the chest, centered at the location with the deepest pectus excavatum.
Press the device into the chest to create a seal.
Use the hand pump to remove air from the device.
Disconnect the pump and plug the end of the tubing to allow free movement while the device is in use, and leave it on for the amount of time recommended by the medical care provider.
Lift the device off the chest.

Is it painful?

The first few uses of the vacuum bell can be uncomfortable or a little painful, but as the device is used more, the pain or discomfort typically goes away. The pressure used by the vacuum bell is adjustable, and changing the pressure can lessen these symptoms [1]. Most people take time to get used to the bell [2].

Are there side effects?

In some cases, the vacuum bell can cause temporary mild side effects, including localized skin irritation, localized pain, or a hematoma at the deepest part of the pectus [1].

Is the vacuum bell successful in treating pectus?

Yes, the vacuum bell can be successfully used to treat pectus [1] [4]. However, there have been no studies about the success of the vacuum bell in the long term (15+ years), so we don't know if the vacuum bell permanently fixes pectus or not [1].

What kinds of pectus patients should use the vaccum bell?

The vacuum bell can be used for patients of all ages, but it works best for those with symmetric and mild pectus who want to avoid surgery or are too young for surgery [4] [5]. Preliminary results recommend starting vacuum bell therapy before age 10, during puberty when the chest wall is more flexible. The deeper the pectus and the older the patient, the more months the vacuum bell should be used for [1]. Patients with severe pectus normally are recommended to undergo surgery.

References

1. Haecker, F.-M., & Sesia, S. (2016). Vacuum bell therapy. Annals of
Cardiothoracic Surgery, 5(5), 440-449. https://doi.org/10.21037/
acs.2016.06.06

2. Barker, J. (Ed.). (n.d.). Vacuum bell therapy: A nonsurgical option for chest
wall depression (pectus excavatum). Boston Children's Hospital.
https://answers.childrenshospital.org/vacuum-bell-therapy/
#:~:text=Vacuum%20bell%20therapy%20is%20not,cause%20pain%20or%20feel%20uncomforta
ble.

3. Haecker, F.-M., & Mayr, J. (2006). The vacuum bell for treatment of pectus
excavatum: An alternative to surgical correction? European Journal of
Cardio-Thoracic Surgery, 29(4), 557-561. https://doi.org/10.1016/
j.ejcts.2006.01.025

4. Loufopoulos, I., Karagiannidis, I. G., Lampridis, S., Mitsos, S., &
Panagiotopoulos, N. (2021). Vacuum bell: Is it a useful innovative device
for pectus excavatum correction? Turkish Thoracic Journal, 22(3), 251-256.
https://doi.org/10.5152/turkthoracj.2021.20035

5. Obermeyer RJ, Cohen NS, Kelly RE. Nonoperative management of pectus excavatum with vacuum bell therapy: a single center study. J Pediatr Surg. 2018;53(6):1221–1225.. 10.1016/j.jpedsurg.2018.02.088)

6. Anzilotti, A. W., M.D. (Ed.). (n.d.). Pectus excavatum: Vacuum bell device.
Nemours KidsHealth. https://kidshealth.org/en/parents/
vacuum-bell-device.html