Minimally invasive versus open repair of Bochdalek hernia: a meta-analysis.
BACKGROUND
Diaphragmatic hernia can be repaired by open or minimally invasive surgery (MIS), although it is unclear which technique has better outcomes. Our objective was to compare the outcomes of these procedures in a systematic review and meta-analysis.


METHODS
We sought all publications describing both techniques through MEDLINE, Embase, and CENTRAL. Our primary outcome of interest was recurrence. We conducted statistical analyses using Review Manager 5.2.


RESULTS
We did not identify any randomized controlled trials. Our pooled estimate of results from 10 studies showed that total recurrence was higher after MIS (OR: 2.81 [1.73, 4.56], p<0.001). Subgroup analyses indicated higher recurrence after MIS for patch repairs (OR: 4.29 [2.13, 8.67], p<0.001), but not for primary repairs. Operative time was longer for MIS (MD: 55.25 [40.21, 70.28], p<0.001), while postoperative ventilator time and postoperative mortality were higher after open surgery (MD: 1.33 [0.05, 2.62], p= 0.04; OR: 7.54 [3.36, 16.90], p<0.001, respectively).


CONCLUSIONS
Recurrence rate is higher after MIS than open repair when a patch is used. Operative time is also longer with MIS. Poorer outcomes after open surgery may be a result of selection bias rather than surgical technique. Surgeons should carefully consider the potential morbidity associated with MIS when deciding on a repair method.
Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
Emily
E
Chan
Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
Carolyn
C
Wayne
Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada. Electronic address: anasr@cheo.on.ca.
Ahmed
A
Nasr
D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D011183:Postoperative Complications; D017594:Publication Bias; D012008:Recurrence; D012121:Respiration, Artificial; D013526:Surgical Mesh; D013908:Thoracotomy; D016896:Treatment Outcome
Congenital diaphragmatic hernia; Minimally invasive surgery; Outcomes; Recurrence