Abstract：
Introduction: Surgical intervention is the definitive management for congenital diaphragmatic hernia (CDH) repair from 1902. Since this time, two mainstay approaches have been used, open and minimally invasive surgical (MIS) repair. An invasive laparotomy is used in around 91% of cases. So, this systematic review of the published literature will compare the surgical outcomes of open (CDH) repair vs MIS for CDH repair and will determine which approach is superior. Material and Methods: Our literature search across MEDLINE and EMBASE included articles from 2004 to 2022, incorporating pediatric CDH repairs, human subjects only, and English language articles. Primary outcomes analyzed were rate of recurrence, length of surgery, length of hospital stay, use of diaphragmatic patch, mortality, postoperative chylothorax, and extracorporeal membrane oxygenation (ECMO) use postoperatively. Results: After application of exclusion criteria, 32 articles were reviewed. Comparison of MIS repair versus open repair had a rate of recurrence at 8.6% versus 1.6% (P < .00001). Length of hospital stay was 19.6 days versus 33.6 days (P = .0012), mortality rate at 4.6% versus 16.6% (P < .0001), patch repair required in 19.6% versus 55.4% (P = < .00001), and postoperative ECMO use of 3.7% versus 12.3% (P < .00001), respectively. Conclusion: MIS repair is associated with decreased length of hospital stay, reduced mortality rate, and postoperative ECMO usage. Hernia recurrence is still high among MIS repair groups compared to the open repair groups. Large, multicentered randomized control trials are recommended for further analysis to decipher the true superior surgical intervention.
摘要：
简介：从1902年开始，手术干预是先天性膈疝（CDH）修复的最终治疗方法。从这次开始,使用了两种主要方法，开放和微创手术（MIS）修复。大约91％的病例使用了侵入性剖腹手术。所以,这项对已发表文献的系统综述将比较开放(CDH)修复与MIS治疗CDH的手术结局,并确定哪种方法更优.材料和方法：我们在MEDLINE和EMBASE中的文献检索包括2004年至2022年的文章，包括儿科CDH修复，只有人类受试者，和英语文章。分析的主要结果是复发率，手术长度,住院时间,使用膈肌贴片，死亡率,术后乳糜胸，术后使用体外膜氧合（ECMO）。结果：应用排除标准后，回顾了32篇文章。MIS修复与开放修复的比较，复发率分别为8.6％和1.6％（P<.00001）。住院时间分别为19.6天和33.6天（P=.0012），死亡率分别为4.6%和16.6%（P<0.0001），补丁修复需要19.6%对55.4%(P=<.00001)，术后ECMO使用率分别为3.7%和12.3%(P<.00001)，分别。结论:MIS修复与住院时间缩短有关,降低死亡率,和术后ECMO的使用。与开放修复组相比，MIS修复组的疝复发率仍然很高。大,多中心随机对照试验建议进行进一步分析，以破译真正的高级手术干预。
