Pediatr Surg Int

. 2024 Jul 9;40(1):182.

 doi: 10.1007/s00383-024-05760-7. https://pubmed.ncbi.nlm.nih.gov/38980431/

Comprehensive meta-analysis of surgical procedure for congenital diaphragmatic hernia: thoracoscopic versus open repair

Soichi Shibuya ^1 2, Irene Paraboschi ³, Stefano Giuliani ⁴, Takafumi Tsukui ⁵, Andreea Matei ⁶, Maricarmen Olivos ⁷, Mikihiro Inoue ⁸, Simon A Clarke ⁷, Atsuyuki Yamataka ⁵, Augusto Zani ^4 9, Simon Eaton ¹⁰, Paolo De Coppi ^11 12

Affiliations expand

• PMID: 38980431
• PMCID: PMC11233350
• DOI: 10.1007/s00383-024-05760-7

Abstract

Purpose: Previous studies have shown a higher recurrence rate and longer operative times for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) compared to open repair (OR). An updated meta-analysis was conducted to re-evaluate the surgical outcomes of TR.

Methods: A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588).

Results: Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02].

Conclusions: TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease.

Keywords: Bowel obstruction; Congenital diaphragmatic hernia; Meta-analysis; Minimally invasive surgery; Neonatal surgery; Thoracoscopy.

© 2024. The Author(s).