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Open Versus Laparoscopic Approach for Morgagni's Hernia in Infants and Children: A Systematic Review and
Giuseppe Lauriti1,2, Elke Zani-Ruttenstock1, Vincenzo D Catania1
11 Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto , Toronto, Canada .
Introduction:
The laparoscopic repair of Morgagni's hernia (MH) has been reported to be safe and feasible. However, it is still unclear whether laparoscopy is superior to open surgery in repairing MH.
Materials And Methods:
Using a defined search strategy, three investigators independently identified all comparative studies reporting data on open and laparoscopic MH repair in patients <18 years of age. Case reports and opinion articles were excluded. Meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3. Data are expressed as mean ± SD.
Results:
Systematic review - Of 774 titles/abstracts screened, 51 full-text articles were analyzed. Three studies were included (92 patients), with 53 (58%) open approaches and 39 (42%) laparoscopy. Meta-analysis - The length of surgery was shorter in laparoscopy (50.5 ± 17.0 min) than in open procedure (90.0 ± 15.0 min; P < .00001). Laparoscopy shortened the length of hospital stay (2.1 ± 1.4 days) versus open surgery (4.5 ± 2.1 days; P < .00001). There was no difference with regards to complications (laparoscopy: 8.8% ± 5.5%, open: 9.4% ± 1.6%; P = .087) and recurrences (laparoscopy: 2.9% ± 5.0%, open: 5.7% ± 1.8%; P = .84).
Discussion:
Comparative studies indicate that laparoscopic MH repair can be performed in infants and children. Laparoscopy is associated with shortened length of surgery and hospital stay in comparison to open procedure. Prospective randomized studies would be needed to confirm present data.
Insights
Laparoscopic repair of Morgagni's hernia (MH) in children is safe and effective, significantly reducing surgery and hospital stay durations compared to open surgery. Further randomized trials are recommended to confirm these findings.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Morgagni's hernia (MH) repair via laparoscopy is considered safe and feasible.
- The superiority of laparoscopic versus open surgery for MH repair in pediatric patients remains uncertain.
Purpose of the Study:
- To compare the efficacy and outcomes of laparoscopic versus open surgical repair of Morgagni's hernia in patients under 18 years of age.
Main Methods:
- A systematic review and meta-analysis were conducted on comparative studies.
- Three studies involving 92 pediatric patients (53 open, 39 laparoscopic) were included.
- Data were analyzed using RevMan 5.3 according to PRISMA guidelines.
Main Results:
- Laparoscopic MH repair was associated with significantly shorter operative times (50.5 min vs. 90.0 min) and hospital stays (2.1 days vs. 4.5 days) compared to open repair.
- No significant differences were observed in complication rates (8.8% vs. 9.4%) or recurrence rates (2.9% vs. 5.7%) between the two approaches.
- P-values for operative time and hospital stay were <.00001, indicating statistical significance.
Conclusions:
- Laparoscopic repair of Morgagni's hernia is a viable option for infants and children, offering reduced surgery and hospital stay durations.
- The study highlights the benefits of minimally invasive techniques in pediatric MH repair.
- Prospective randomized controlled trials are needed to definitively confirm these findings.