Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Apr;20(2):297-302.
doi: 10.1007/s10029-015-1423-0. Epub 2015 Oct 5.

Minimally invasive surgery for congenital diaphragmatic hernia: a meta-analysis

Y Zhu  1 , Y Wu  2 , Q Pu  1 , L Ma  1 , H Liao  1 , L Liu  3
Affiliations
Review

Minimally invasive surgery for congenital diaphragmatic hernia: a meta-analysis

Y Zhu et al. Hernia. 2016 Apr.

Abstract

Objectives: To compare the safety and efficacy of minimally invasive surgery (MIS) with traditional open surgical approach for congenital diaphragmatic hernia (CDH).

Methods: A literature search was performed using the PubMed database, Embase, and the Cochrane central register of controlled trials using a defined set of criteria. The outcomes, which include post-operative mortality, incidence of hernia recurrence, rates of patch use and complications, were analyzed.

Results: We investigated nine studies, which included 507 patients. All studies were non-randomized historical control trials. The MIS group had a significantly lower rate of post-operative death with a risk ratio of 0.26 [95% confidence interval (CI) 0.10-0.68; p = 0.006] but a greater incidence of hernia recurrence with a risk ratio of 3.42 (95% CI 1.98-5.88; p < 0.00001). Rates of prosthetic patch use were similar between the two groups. Fewer cases of surgical complications were found in the MIS group with a risk ratio of 0.66 (95% CI 0.47-0.94; p = 0.02).

Conclusions: MIS for CDH repair is associated with lower post-operative mortality and morbidity compared with traditional open repair. Although rate of patch use appears to be comparable, the increased risk of CDH recurrence should not be ignored. The lack of well-controlled prospective trials still limits strong evaluations of the two surgical techniques.

Keywords: Congenital diaphragmatic hernia; Hernia recurrence; Meta-analysis; Minimally invasive surgery.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow of study identification, inclusion and exclusion
Fig. 2
Fig. 2
Forest plot comparing the rates of post-operative death between the MIS and open surgery groups with a fixed effects model
Fig. 3
Fig. 3
Forest plot comparing the rates of recurrence between the MIS and open surgery groups with a fixed effects model
Fig. 4
Fig. 4
Forest plot comparing the rates of patch usage between the MIS and open surgery groups with a random effects model
Fig. 5
Fig. 5
Forest plot comparing the rates of surgical complications between the MIS and open surgery groups with a fixed effects model
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Langham MR, Jr, Kays DW, Ledbetter DJ, Frentzen B, Sanford LL, Richards DS. Congenital diaphragmatic hernia. Epidemiology and outcome. Clin Perinatol. 1996;23:671–688. - PubMed
    1. Silen ML, Canvasser DA, Kurkchubasche AG, Andrus CH, Naunheim KS. Video-assisted thoracic surgical repair of a foramen of Bochdalek hernia. Ann Thorac Surg. 1995;60:448–450. doi: 10.1016/0003-4975(95)00100-Y. - DOI - PubMed
    1. Cho SD, Krishnaswami S, Mckee JC, Zallen G, Silen ML, Bliss DW. Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls. J Pediatr Surg. 2009;44:80–86. doi: 10.1016/j.jpedsurg.2008.10.013. - DOI - PubMed
    1. Gourlay DM, Cassidy LD, Sato TT, Lal DR, Arca MJ. Beyond feasibility: a comparison of newborns undergoing thoracoscopic and open repair of congenital diaphragmatic hernias. J Pediatr Surg. 2009;44:1702–1707. doi: 10.1016/j.jpedsurg.2008.11.030. - DOI - PubMed
    1. Lao OB, Crouthamel MR, Goldin AB, Sawin RS, Waldhausen JH, Kim SS. Thoracoscopic repair of congenital diaphragmatic hernia in infancy. J Laparoendosc Adv Surg Tech A. 2010;20:271–276. doi: 10.1089/lap.2009.0150. - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources