Comprehensive meta-analysis of surgical procedure for congenital diaphragmatic hernia: thoracoscopic versus open repair

Infographic · Oct 2024 · 1 min read

In brief

Meta-analysis of 709 neonatal CDH cases comparing thoracoscopic versus open repair found thoracoscopic approach has 4× higher recurrence rates and 44-minute longer operative times, but significantly reduces postoperative bowel obstruction (5% vs 15%). Results suggest thoracoscopic repair may benefit carefully selected patients despite trade-offs in recurrence risk.

Thoracoscopic CDH repair has 4× higher recurrence rate vs open repair but significantly reduces postoperative bowel obstruction (5% vs 15%)
Operative times for thoracoscopic approach average 44 minutes longer than open repair in neonatal CDH cases
Patient selection is critical—thoracoscopic repair may offer long-term GI benefits but should be reserved for less severe CDH presentations
Meta-analysis of 709 patients confirms trade-off: minimally invasive approach reduces adhesive complications at cost of higher hernia recurrence

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with surgical technique variations. Bar charts or percentage indicators display outcome metrics below each approach.

Soichi Shibuya, Irene Paraboschi, Stefano Giuliani, Takafumi Tsukui, Andreea Matei, Maricarmen Olivos, Mikihiro Inoue, Simon A Clarke, Atsuyuki Yamataka, Augusto Zani, Simon Eaton, Paolo De Coppi

Purpose: 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.

Methods: A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588).

Results: 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].

Conclusions: 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.

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