What are the current approaches to pectus excavatum repair?

Vacuum bell therapy applies suction to the anterior chest to draw the sternum forward over months of daily use. It suits milder, more elastic deformities, particularly in younger patients, and requires sustained adherence.

Physiotherapy and posture programmes do not correct the bony deformity but are often used alongside other approaches.

A curved metal bar is passed behind the sternum through the pleural space via lateral incisions, then rotated to push the sternum forward. The bar remains in place for two to three years before removal in a second procedure.

It avoids cartilage resection and large incisions, but requires intrathoracic passage of the bar — historically the source of its most serious reported complications — and postoperative pain management is a significant part of recovery.

Abnormal costal cartilage is resected and the sternum is repositioned and stabilised, often with a temporary support or rigid fixation. It handles complex, asymmetric and mixed deformities well, at the cost of a larger anterior incision and more extensive dissection.

Extrapleural techniques lift the sternum from the front and fix it with a plate and support, without entering the pleural cavity or passing a bar behind the sternum. The intent is to remove the intrathoracic risk category altogether and to reduce postoperative pain relative to bar techniques.

Technique selection depends on deformity morphology, patient age and skeletal maturity, symptoms and surgeon experience; comparative outcome data continues to develop and should be discussed case by case.