Keita Terui1, Kouji Nagata2, Miharu Ito3, Masaya Yamoto4, Masayuki Shiraishi5, Tomoaki Taguchi2, Masahiro Hayakawa3, Hiroomi Okuyama6, Hideo Yoshida7, Kouji Masumoto8, Yutaka Kanamori9, Keiji Goishi10, Naoto Urushihara4, Motoyoshi Kawataki11, Noboru Inamura12, Osamu Kimura13, Tadaharu Okazaki14, Katsuaki Toyoshima15, Noriaki Usui16. 1. Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8677, Japan. kta@cc.rim.or.jp. 2. Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan. 3. Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan. 4. Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. 5. Osaka University Library, Osaka, Japan. 6. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 7. Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8677, Japan. 8. Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 9. Department of General Surgery, National Center for Child Health and Development, Tokyo, Japan. 10. Division of Neonatology, Department of Maternal and Perinatal Medicine, National Center for Child Health and Development, Tokyo, Japan. 11. Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Japan. 12. Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. 13. Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. 14. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan. 15. Section of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan. 16. Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Abstract
PURPOSE: The optimal surgical approach for neonatal congenital diaphragmatic hernia (CDH) remains unclear. We conducted a systematic review and meta-analysis of the effectiveness of endoscopic surgery (ES) for neonatal CDH. METHODS: A systematic literature search was conducted using MEDLINE and the Cochrane Library. Studies that compared surgical approaches for neonatal CDH were selected. Mortality and recurrence of herniation were analyzed as primary endpoints. Each study was evaluated following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: Eight observational studies comparing ES and open surgery (OS) met the criteria. As compared with the OS group, the ES group showed both a significantly lower mortality rate [risk ratio (RR) 0.18, 95 % confidence interval (CI) 0.09-0.38, p < 0.0001] and a significantly higher recurrence rate (RR 3.10, 95 % CI 1.95-4.88, p < 0.00001). However, serious selection bias was seen in seven of the eight studies-because the indication of ES had been determined intentionally, the ES groups may have included less severe cases. CONCLUSION: Although the evidence was insufficient, ES was clearly associated with more recurrence than was OS. Therefore, ES should not be the routine treatment for every neonate. It is crucially important to select suitable cases for ES.
PURPOSE: The optimal surgical approach for neonatal congenital diaphragmatic hernia (CDH) remains unclear. We conducted a systematic review and meta-analysis of the effectiveness of endoscopic surgery (ES) for neonatal CDH. METHODS: A systematic literature search was conducted using MEDLINE and the Cochrane Library. Studies that compared surgical approaches for neonatal CDH were selected. Mortality and recurrence of herniation were analyzed as primary endpoints. Each study was evaluated following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: Eight observational studies comparing ES and open surgery (OS) met the criteria. As compared with the OS group, the ES group showed both a significantly lower mortality rate [risk ratio (RR) 0.18, 95 % confidence interval (CI) 0.09-0.38, p < 0.0001] and a significantly higher recurrence rate (RR 3.10, 95 % CI 1.95-4.88, p < 0.00001). However, serious selection bias was seen in seven of the eight studies-because the indication of ES had been determined intentionally, the ES groups may have included less severe cases. CONCLUSION: Although the evidence was insufficient, ES was clearly associated with more recurrence than was OS. Therefore, ES should not be the routine treatment for every neonate. It is crucially important to select suitable cases for ES.
Entities:
Keywords:
Congenital diaphragmatic hernia; Conversion to open surgery, reoperation, meta-analysis; Minimally invasive surgical procedures; Video-assisted thoracic surgery
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