title: Neonatal endosurgical congenital diaphragmatic hernia repair: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare outcomes of open and endosurgical neonatal congenital diaphragmatic hernia (CDH) repairs.
  
  
  BACKGROUND
  Historically a surgical emergency, neonatal CDH repair is now deferred pending stabilization of characteristically labile cardiopulmonary physiology. Usually accomplished via laparotomy, surgical repair may acutely worsen lung function; conversely, by reducing the visceral hernia, surgery might improve it. Theoretically, endosurgical repair could minimize deleterious effects of surgery while garnering benefits from decompressing the CDH lung. As endosurgical repair gains popularity, it is important to investigate whether or not minimally-invasive neonatal CDH repair has benefits.
  
  
  METHODS
  We searched Medline, Embase, and Cochrane Trials databases for studies comparing open with endosurgical CDH repair. Non-neonatal series and reports without comparison groups were excluded. References from papers and conference proceedings were also hand searched. Meta-analysis used a fixed effects model and was reported in accordance with PRISMA.
  
  
  RESULTS
  We included 3 studies (1 unpublished; none randomized); all compared thoracoscopic and open CDH repair and together described 143 patients. All studies had limitations, including use of historical controls. Demographics, CDH sidedness, APGAR and associated anomaly prevalence were similar between groups. For endosurgical repair, recurrence was higher (RR: 3.2 [1.1, 9.3], P = 0.03) and operative time longer (WMD 50 minutes [32, 69], P < 0.00001). Survival and patch usage were not different between open and endosurgical groups.
  
  
  CONCLUSIONS
  Neonatal thoracoscopic CDH repair has greater recurrence rates and operative times but similar survival and patch usage compared with open surgery. A prospective registry for all such cases would guide development of trials (Stage 2b; IDEAL recommendations).
authors.affiliation: Division of Child Health, University of Liverpool and Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Lansdale
authors.forename: Sabrina
authors.initials: S
authors.lastname: Alam
authors.forename: Paul D
authors.initials: PD
authors.lastname: Losty
authors.forename: Edwin C
authors.initials: EC
authors.lastname: Jesudason
mesh_terms: D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D012008:Recurrence; D013906:Thoracoscopy