{Reference Type}: Journal Article
{Title}: Comprehensive meta-analysis of surgical procedure for congenital diaphragmatic hernia: thoracoscopic versus open repair.
{Author}: Shibuya S;Paraboschi I;Giuliani S;Tsukui T;Matei A;Olivos M;Inoue M;Clarke SA;Yamataka A;Zani A;Eaton S;De Coppi P;
{Journal}: Pediatr Surg Int
{Volume}: 40
{Issue}: 1
{Year}: 2024 Jul 9
{Factor}: 2.003
{DOI}: 10.1007/s00383-024-05760-7
{Abstract}: <B>OBJECTIVE: </B>Previous studies have shown a higher recurrence rate and longer operative times for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) compared to open repair (OR). An updated meta-analysis was conducted to re-evaluate the surgical outcomes of TR.<BR><B>METHODS: </B>A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588).<BR><B>RESULTS: </B>Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02].<BR><B>CONCLUSIONS: </B>TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease.