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Minimally invasive surgery for congenital diaphragmatic hernia: a meta-analysis
1Department of Thoracic Surgery, West China Hospital, Sichuan University, No 37, Guo Xue Xiang, 610041, Chengdu, People's Republic of China.
Objectives:
To compare the safety and efficacy of minimally invasive surgery (MIS) with traditional open surgical approach for congenital diaphragmatic hernia (CDH).
Methods:
A literature search was performed using the PubMed database, Embase, and the Cochrane central register of controlled trials using a defined set of criteria. The outcomes, which include post-operative mortality, incidence of hernia recurrence, rates of patch use and complications, were analyzed.
Results:
We investigated nine studies, which included 507 patients. All studies were non-randomized historical control trials. The MIS group had a significantly lower rate of post-operative death with a risk ratio of 0.26 [95% confidence interval (CI) 0.10-0.68; p = 0.006] but a greater incidence of hernia recurrence with a risk ratio of 3.42 (95% CI 1.98-5.88; p < 0.00001). Rates of prosthetic patch use were similar between the two groups. Fewer cases of surgical complications were found in the MIS group with a risk ratio of 0.66 (95% CI 0.47-0.94; p = 0.02).
Conclusions:
MIS for CDH repair is associated with lower post-operative mortality and morbidity compared with traditional open repair. Although rate of patch use appears to be comparable, the increased risk of CDH recurrence should not be ignored. The lack of well-controlled prospective trials still limits strong evaluations of the two surgical techniques.
Insights
Minimally invasive surgery (MIS) for congenital diaphragmatic hernia (CDH) repair shows lower mortality and complications than open surgery. However, MIS is linked to a higher recurrence rate, necessitating careful consideration in surgical approach selection.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Hernia Repair
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring surgical intervention.
- Traditional open surgical repair has been the standard approach for CDH.
- Minimally invasive surgery (MIS) offers potential advantages in surgical outcomes.
Purpose of the Study:
- To compare the safety and efficacy of MIS versus traditional open surgery for CDH.
- Evaluate key post-operative outcomes including mortality, recurrence, and complications.
- Assess the use of prosthetic patches in both surgical approaches.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane central register.
- Inclusion of nine non-randomized historical control trials involving 507 patients.
- Analysis of post-operative mortality, hernia recurrence, patch use, and complication rates.
Main Results:
- MIS group demonstrated significantly lower post-operative mortality (RR 0.26, p=0.006).
- MIS group showed a higher incidence of hernia recurrence (RR 3.42, p<0.00001).
- MIS group had fewer surgical complications (RR 0.66, p=0.02), with similar patch use rates.
Conclusions:
- MIS for CDH repair is associated with reduced post-operative mortality and morbidity.
- Increased risk of CDH recurrence with MIS requires careful attention.
- Further high-quality prospective trials are needed to definitively evaluate MIS versus open repair for CDH.
