Comprehensive meta-analysis of surgical procedure for congenital diaphragmatic hernia: thoracoscopic versus open repair
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In brief
In brief
This meta-analysis of 709 neonatal CDH cases compares thoracoscopic versus open repair, finding thoracoscopic approach has higher recurrence rates and longer operative times but significantly reduces postoperative bowel obstruction. Results emphasize careful patient selection for minimally invasive repair to balance short-term risks against potential long-term benefits.
- Thoracoscopic CDH repair has 4× higher recurrence risk vs open repair (OR 4.03), requiring careful patient selection
- Thoracoscopic approach takes ~44 minutes longer operatively but reduces postoperative bowel obstruction by 58% (5% vs 14.8%)
- Meta-analysis of 709 neonates confirms thoracoscopic repair best reserved for less severe CDH cases
- Long-term benefit of reduced bowel obstruction may offset higher recurrence in selected thoracoscopic CDH patients
Written by the GCMD Library team from the article.
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.