Pectus excavatum research: the studies, summarized
By Javier Santana, founder of Pectus Academy · Updated October 2026
Short answer: this page gathers the main studies and medical sources our guides rely on, with what each one found and its main limitation. Surgery is the option with the most studies; the evidence is limited for the vacuum bell and almost nonexistent for exercise alone and for the bell in adults.
How should you read these studies?
- Look at who the patients were. Most are children and teenagers seen in hospitals, often with a marked pectus.
- Look at how success is defined. Each study defines it in its own way, so the percentages cannot be compared with each other.
- Look at who is counted. Several only count those who finished treatment.
In several cases we worked from the published abstract, without access to the full text.
Vacuum bell
| Study | Who | Result and limitation |
|---|---|---|
| Haecker, 2011 (Basel) | 133 patients aged 3 to 61, median 16 | 105 showed a lift of more than 1 cm at 3 months; 13 went on to have surgery. Single-center series with no control group. |
| Lopez et al., 2015 | Not stated | Correction in 31.5% overall and in 37.5% of pediatric patients. Figure taken from a later review, not from the original study. |
| Haecker and Sesia, 2016 (Basel) | 140 patients aged 3 to 61 | 61 reached a normal level after 21.8 months on average; 25 stopped. No control group; 54 were still in treatment. |
| Alaca et al., 2020 | 26 boys aged 11 to 18 | Bell plus physical therapy did better than the bell alone at 12 weeks. A small, short randomized trial. |
| Lei et al., 2024 | 72 patients analyzed, out of 98 | Excellent correction in 25.0%, good in 18.1% and fair in 5.6%. Better when starting at age 11 or younger and when used for more than 24 consecutive months. Retrospective. |
| van Braak et al., 2025 (Amsterdam) | 259 patients | Success in 86 of the 165 who completed treatment (52.1%). The percentage is based only on those who finished. |
| SHTG, 2025 (Scotland) | Assessment of 15 studies | Positive results in roughly 20-50% in recent studies. Evidence prone to bias and focused on children and teenagers. |
Explained in vacuum bell: how it works and what the evidence says.
Exercise and physical therapy
- Alaca et al., 2020: the only randomized trial we have found, and it studies physical therapy added to the bell, not exercise alone.
- Mayo Clinic: some physical therapy exercises may improve posture and chest expansion.
- Seattle Children's: no medication or exercise has been shown to improve pectus excavatum.
Explained in exercises: what helps and what doesn't and in vacuum bell and exercises.
Heart, lungs and exercise capacity
| Study | Who | Result and limitation |
|---|---|---|
| Lesbo et al., 2011 | 49 teenagers with pectus and 26 without | During submaximal exercise, cardiac index of 6.6 vs 8.0 L/min/m²; no differences at rest. |
| Casatori et al., 2022 | 15 teenagers with pectus and 15 without | Maximum oxygen uptake of 37.2 vs 45.4 mL/kg/min; more physical activity, better uptake. Pilot study. |
| StatPearls, 2026 (review) | Meta-analysis of 15 studies | No significant change in maximum oxygen uptake before and after surgery. |
Explained in pectus excavatum and sports.
How it is measured and the shapes it takes
| Study | Who | Result |
|---|---|---|
| Haller et al., 1987 | Patients assessed with CT scans | Patients who went on to surgery had an index above 3.25. This is where the Haller index comes from. |
| St Peter et al., 2011 | 252 patients with pectus and 220 without | The Haller index overlapped by 47.8% between the two groups. They propose the correction index. |
| Kelly et al., 2013 | 283 patients aged 4 to 30, with CT scans | Cup-shaped in 67%, saucer-shaped in 21%, trench-like in 10% and mixed in 1%. |
Explained in Haller index and in what is pectus excavatum?
Body image
| Study | Who | Result and limitation |
|---|---|---|
| Steinmann et al., 2011 | 71 people with pectus excavatum, 19 with pectus carinatum and 82 with no deformity | Body image highly disturbed in patients, linked to worse mental quality of life and lower self-esteem. Patients assessed before surgery. |
| Kelly et al., 2008 | 264 patients aged 8 to 21, at 11 hospitals | One year after surgery, body image difficulties fell from 2.30 to 1.40 out of 4. No comparison group. |
Explained in body image and confidence.
Surgery in adults
| Study | Who | Result and limitation |
|---|---|---|
| Rshaidat et al., 2024 | Registry of 2,843 patients who had surgery | Adults had more bleeding (3% vs 0.86%) and more acute pain (55% vs 39.1%) than minors. |
| Çetinkaya et al., 2026 | 16 patients aged 40 or older | Complications in 31.3%. The authors conclude that age alone should not be a contraindication. A very small series. |
| Akhtar et al., 2023 | Review of studies in adults who had surgery | Most common complications: bar displacement, infection, pneumothorax and chronic pain. Most patients were satisfied. |
Explained in pectus excavatum surgery and in is it too late at 20, 30 or 40?
Pectus carinatum
- StatPearls, 2023: compression brace for 14 to 24 hours a day, most effective before the growth spurt.
- Frediani et al., 2024: 140 children and teenagers with a custom-made brace; complete resolution in 34.8%. A preliminary, single-center study.
Explained in pectus excavatum vs pectus carinatum.
What still needs to be studied?
- The vacuum bell in adults, with results broken down by age.
- Exercise and posture on their own, without the bell or surgery.
- Head-to-head comparisons of surgery and the bell in moderate cases.
- Very long-term results for the bell.
What we know and what we don't
What we know
- What each study on this page reports, with its limitation.
What we don't know
- Whether we have missed relevant studies: this is not a systematic review.
If you know of a study that should be here, write to us through the contact page. Last reviewed: October 2026.
This content is educational and does not replace the advice of a healthcare professional. We do not promise a specific result.
Sources
- Haecker FM. The vacuum bell for conservative treatment of pectus excavatum: the Basle experience. Pediatric Surgery International, 2011;27(6):623-627.
- Haecker FM, Sesia S. Vacuum bell therapy. Annals of Cardiothoracic Surgery, 2016. annalscts.com
- Obermeyer RJ. Incorporating vacuum bell therapy into pectus excavatum treatment. Journal of Visualized Surgery, 2016;2:99. Source of the Lopez et al. figure.
- Alaca N, Alaca I, Yuksel M. Physiotherapy in addition to vacuum bell therapy in patients with pectus excavatum. Interactive Cardiovascular and Thoracic Surgery, 2020;31(5):661-668. doi.org/10.1093/icvts/ivaa161
- Lei W, Shao M, Hu Y, et al. Vacuum bell therapy for pectus excavatum: a retrospective study. BMC Pediatrics, 2024;24. doi.org/10.1186/s12887-024-04615-3
- van Braak H, de Beer SA, al Ghouch Y, et al. 15 Years of Vacuum Bell Therapy for Pectus Excavatum: Long-term Outcomes and Influencing Factors. Journal of Pediatric Surgery, 2025;60(2):161891.
- Scottish Health Technologies Group. Vacuum bell device for the correction of pectus excavatum, June 2, 2025. shtg.scot
- Lesbo M, Tang M, Nielsen HH, et al. Compromised cardiac function in exercising teenagers with pectus excavatum. Interactive Cardiovascular and Thoracic Surgery, 2011;13(4):377-380. doi.org/10.1510/icvts.2011.267054
- Casatori, Pellegrino, Messineo, et al. Differential Influence of Physical Activity on Cardiopulmonary Performance and Stroke Volume Assessed at Cardiopulmonary Exercise Test in Pectus Excavatum: A Pilot Study. Frontiers in Physiology, 2022;13:831504. doi.org/10.3389/fphys.2022.831504
- Haller JA, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. Journal of Pediatric Surgery, 1987.
- St Peter SD, Juang D, Garey CL, et al. A novel measure for pectus excavatum: the correction index. Journal of Pediatric Surgery, 2011;46(12):2270-2273.
- Kelly RE Jr, Quinn A, Varela P, Redlinger RE, Nuss D. Dysmorphology of Chest Wall Deformities: Frequency Distribution of Subtypes of Typical Pectus Excavatum and Rare Subtypes. Archivos de Bronconeumología, 2013;49:196-200. archbronconeumol.org
- Steinmann C, et al. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image. European Journal of Cardio-Thoracic Surgery, 2011;40(5):1138-1145.
- Kelly RE Jr, Cash TF, Shamberger RC, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. Pediatrics, 2008;122(6):1218-1222. doi.org/10.1542/peds.2007-2723
- Rshaidat et al. Annals of Thoracic Surgery Short Reports, 2024. PubMed 39790407
- Çetinkaya et al. Journal of Cardiothoracic Surgery, 2026. PubMed 41691289
- Akhtar et al. Cureus, 2023. PubMed 36960268
- McHam B, Winkler L. Pectus Carinatum. StatPearls, updated July 31, 2023. ncbi.nlm.nih.gov/books/NBK541121
- Frediani S, Zarfati A, Pardi V, et al. A new custom-made bivalve brace for pectus carinatum in children and adolescents: preliminary promising experience of 140 patients from a tertiary center. Frontiers in Pediatrics, 2024;12:1321633. doi.org/10.3389/fped.2024.1321633
- Sharma G, Carter YM. Pectus Excavatum. StatPearls, updated February 15, 2026. ncbi.nlm.nih.gov/books/NBK430918
- Mayo Clinic. Pectus excavatum: diagnosis and treatment, updated March 14, 2025. mayoclinic.org
- Seattle Children's Hospital. Pectus Excavatum. seattlechildrens.org
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