Open Versus Laparoscopic Approach for Morgagni's Hernia in Infants and Children: A Systematic Review and Meta-Analysis

Abstract

Introduction:

The laparoscopic repair of Morgagni's hernia (MH) has been reported to be safe and feasible. However, it is still unclear whether laparoscopy is superior to open surgery in repairing MH.

Materials and Methods:

Using a defined search strategy, three investigators independently identified all comparative studies reporting data on open and laparoscopic MH repair in patients <18 years of age. Case reports and opinion articles were excluded. Meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3. Data are expressed as mean ± SD.

Results:

Systematic review - Of 774 titles/abstracts screened, 51 full-text articles were analyzed. Three studies were included (92 patients), with 53 (58%) open approaches and 39 (42%) laparoscopy. Meta-analysis - The length of surgery was shorter in laparoscopy (50.5 ± 17.0 min) than in open procedure (90.0 ± 15.0 min; P < .00001). Laparoscopy shortened the length of hospital stay (2.1 ± 1.4 days) versus open surgery (4.5 ± 2.1 days; P < .00001). There was no difference with regards to complications (laparoscopy: 8.8% ± 5.5%, open: 9.4% ± 1.6%; P = .087) and recurrences (laparoscopy: 2.9% ± 5.0%, open: 5.7% ± 1.8%; P = .84).

Discussion:

Comparative studies indicate that laparoscopic MH repair can be performed in infants and children. Laparoscopy is associated with shortened length of surgery and hospital stay in comparison to open procedure. Prospective randomized studies would be needed to confirm present data.

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References

Federico

, Ponn

. Foramen of Morgagni hernia. In: Shields

, LoCicero

III , Ponn

(eds). General Thoracic Surgery, 5th Edition. Philadelphia: Lippincott Williams and Wilkins, 2000; pp. 647–660.

Zani

, Cozzi

. Giovanni Battista Morgagni and his contribution to pediatric surgery. J Pediatr Surg, 2008; 43:729–733.

Alqahtani

, Al-Salem

. Laparoscopic-assisted versus open repair of Morgagni Hernia in infants and children. Surg Laparosc Endosc Percutan Tech, 2011; 21:46–49.

Kuster

, Kline

, Garzo

. Diaphragmatic hernia through the foramen of Morgagni: Laparoscopic repair case report. J Laparoendoscopic Surg, 1992; 2:93–100.

Ponsky

, Lukish

, Nobuhara

, et al. Laparoscopy is useful in the diagnosis and management of foramen of Morgagni hernia in children. Surg Laparosc Endosc Percutan Tech, 2002; 12:375–377.

Mallik

, Alqahtani

. Laparoscopic-assisted repair of Morgagni hernia in children. J Pediatr Surg, 2009; 44:1621–1624.

Lamas-Pinheiro

, Pereira

, Carvalho

, et al. Minimally invasive repair of Morgagni hernia—A multicenter case series. Rev Port Pneumol (2006), 2016; 22:273–278.

Esposito

, Escolino

, Varlet

, et al. Technical standardization of laparoscopic repair of Morgagni diaphragmatic hernia in children: Results of a multicentric survey on 43 patients. Surg Endosc, 2017; 31:3320–3325.

Moher

, Liberati

, Tetzlaff

, et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med, 2009; 21;6:e1000097.

10.

PROSPERO International Prospective Register of Systematic Reviews. www.crd.york.ac.uk/prospero/about.php?about=about (accessed July 15, 2017).

11.

Review Manager (RevMan). 5.3. Copenhagen: The Nordic Cochrane Centre. London, UK: The Cochrane Collaboration, 2014.

12.

Hozo

, Djulbegovic

, Hozo

. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005; 20;5:13.

13.

Slim

, Nini

, Forestier

, et al. Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument. ANZ J Surg, 2003; 73:712–716.

14.

Shea

, Grimshaw

, Wells

, et al. Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007; 7:10.

15.

Jetley

, Al-Assiri

, Al-Helal

, et al. Down's syndrome as a factor in the diagnosis, management, and outcome in patients of Morgagni hernia. J Pediatr Surg, 2011; 46:636–639.

16.

Laituri

, Garey

, Ostlie

, et al. Morgagni hernia repair in children: Comparison of laparoscopic and open results. J Laparoendosc Adv Surg Tech A, 2011; 21:89–91.

17.

Al-Salem

, Zamakhshary

, Al Mohaidly

, et al. Congenital Morgagni's hernia: A national multicenter study. J Pediatr Surg, 2014; 49:503–507.

18.

Zani

, Zani-Ruttenstock

, Pierro

. Advances in the surgical approach to congenital diaphragmatic hernia. Semin Fetal Neonatal Med, 2014; 19:364–369.

19.

Aydin

, Altuntas

, Ulas

, et al. Morgagni hernia: Transabdominal or transthoracic approach?. Acta Chir Belg, 2014; 114:131–135.

20.

Ambrogi

, Forcella

, Gatti

, et al. Transthoracic repair of Morgagni's hernia: A 20-year experience from open to video-assisted approach. Surg Endosc, 2007; 21:587–591.

21.

Kiliç

, Nadir

, Döner

, et al. Transthoracic approach in surgical management of Morgagni hernia. Eur J Cardiothorac Surg, 2001; 20:1016–1019.

22.

Shah

, Wishnew

, Barsness

, et al. Minimally invasive congenital diaphragmatic hernia repair: A 7-year review of one institution's experience. Surg Endosc, 2009; 23:1265–1271.

23.

Mattei

. Congenital Diaphragmatic Hernia. In: Mattei

(ed). Fundamentals of Pediatric Surgery, 1st Editionn. New York: Springer, 2011, pp. 535–542.

24.

Azzie

, Maoate

, Beasley

, et al. A simple technique of laparoscopic full-thickness anterior abdominal wall repair of retrosternal (Morgagni) hernias. J Pediatr Surg, 2003; 38:768–770.

25.

Dutta

, Albanese

. Use of a prosthetic patch for laparoscopic repair of Morgagni diaphragmatic hernia in children. J Laparoendosc Adv Surg Tech A, 2007; 17:391–394.

26.

Huntington

. Laparoscopic transabdominal preperitoneal repair of a hernia of Morgagni. J Laparoendosc Surg, 1996; 6:131–133.

27.

Garriboli

, Bishay

, Kiely

, et al. Recurrence rate of Morgagni diaphragmatic hernia following laparoscopic repair. Pediatr Surg Int, 2013; 29:185–189.

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