Thoracoscopic versus Open Repair of Congenital Diaphragmatic Hernia: A Systematic Review and Meta- Analysis

Shaoguang Feng, Yi Lou, Aihe Wang and Weiguang Liu*

Department of Pediatric Surgery, Hangzhou Children's Hospital, China

^*Correspondance to: Weiguang Liu 

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Abstract:

Purpose: Thoracoscopic surgery is an increasingly popular surgical technique to repair Congenital
Diaphragmatic Hernia (CDH). Here, we performed a systematic review and meta-analysis to
compare the efficacy and safety between thoracoscopic surgery and traditional open surgical
approach for CDH.
Methods: A systematic search of the electronic databases was conducted to identify studies
compared the Thoracoscopic Repair (TR) and Open Repair (OR) for CDH. Parameters such as
operative time, post-operative mortality, incidence of hernia recurrence, rate of patch use and postoperative
complications were pooled and compared by meta-analysis.
Results: Among the 712 children with CDH included in the twelve studies, 309 had received TR
and 403 OR. All studies were non-randomized controlled trials. There were shorter operative times
with the OR compared with TR [95% Confidence Interval (CI) 15.83 to 66.75]. The TR group had
a significantly lower rate of post-operative death [95% Confidence Interval (CI) 0.09 to 0.63] but
a greater incidence of recurrence [95% Confidence Interval (CI) 1.88 to 5.71]. Rates of prosthetic
patch use were similar between the two groups. Fewer cases of surgical complications were found in
the TR group [95% Confidence Interval (CI) 0.21 to 0.67].
Conclusion: Thoracoscopic repair for CDH is associated with lower post-operative mortality
and longer operative times compared with traditional open repair. Although the rate of surgical
complications appears to be lower in TR, the increased risk of CDH recurrence should not be
ignored. More high quality prospective, multicenter, randomized controlled trials are required to
strengthen the conclusion.

Keywords:

Congenital diaphragmatic hernia; Thoracoscopic repair; Meta-analysis; Recurrence

Cite the Article:

Liu W, Feng S, Lou Y, Wang A. Thoracoscopic versus Open Repair of Congenital Diaphragmatic Hernia: A Systematic Review and Meta-Analysis. World J Surg Surgical Res. 2019; 2:1169..