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

1Department of Pediatric Surgery, Hangzhou Children's Hospital, No.195 Wenhui Rd, Xiacheng district, Hangzhou 310015, China.
2Department of Pediatric Surgery, Hangzhou Children's Hospital, No.195 Wenhui Rd, Xiacheng district, Hangzhou 310015, China.
3Department of Pediatric Surgery, Hangzhou Children's Hospital, No.195 Wenhui Rd, Xiacheng district, Hangzhou 310015, China.
4 Department of Pediatric Surgery, Hangzhou Children's Hospital, No.195 Wenhui Rd, Xiacheng district, Hangzhou 310015, China.

Corresponding Author: Weiguang Liu, Department of Pediatric Surgery, Hangzhou Children’s Hospital, No.195 Wenhui Rd, Xiacheng District, Hangzhou 310015, China. 

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 post-operative 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.