Surgical Approaches for Congenital Diaphragmatic Hernia - Thoracoscopic Repair Versus Open Repair: A Systematic Review and Meta-Analysis
Keywords:
Congenital Diaphragmatic Hernia, Minimally Invasive Surgery or Thoracoscopic Repair-TR, Open Repair-OR, Arterial Oxygen level:PaO2, Arterial Carbon dioxide level:PaCO2Abstract
Background: Congenital Diaphragmatic hernia can be treated by Thoracoscopic repair (TR) or Opened repair (OR). Although there’s unclear which technique has better outcome. Objectives: Our primary objective aims to compare outcome in the recurrent rate and mortality rate of TR and OR. The secondary outcome were arterial oxygen, carbon dioxide & pH and the operative time. Method: A systematic literature search was performed through three databases (MEDLINE, PubMED and CLINICALKEY) for studies published from January 1995 until January 2019. The comparison retrospectively studies between TR versus OR were included. Results: Fifthteen observational studies, comparing TR and OR, met the criteria and showed the higher recurrence after TR (Relative risk 2.43, 95% Confidence Interval 1.12 - 5.31, p-value = 0.03) but subgroup analysis in defect size’s studies (Primary and Patch repair) were not statistical significance (Relative risk 1.32 and 95% Confidence Interval 0.20 - 8.62). The mortality rate was lower for TR (TR – 2.09% and OR 17.05%, Relative risk 0.18, 95% Confidence Interval 0.08-0.37, p-value <0.0001). The secondary outcome in arterial oxygen & carbon dioxide, pH were not different but the operative time for TR was longer than OR (Mean Difference 47.99, 95% CI 4.03-15.03, p < 0.0001) and the operative time had the downward trend. Conclusion: Thoracoscoppic repair was the safe technique, during intra operation and had the good outcome because there was no difference in recurrence, better cosmetic, small incision and rapid recovery.
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