Muscle flap repair vs. patch repair in reducing recurrence in congenital diaphragmatic hernia: systematic review with Meta-Analysis.

OBJECTIVE: This meta-analysis aimed to investigate the risk of recurrence after muscle flap repair versus patch repair in neonates with congenital diaphragmatic hernia (CDH). METHODS: Three electronic databases (PubMed, EMBASE, and CENTRAL) were searched from inception until November 1, 2024, to identify studies that compared patch repair and muscle flap repair and reported recurrence rates or any other relevant secondary outcomes in neonates with CDH. Two reviewers independently extracted data and evaluated study quality using ROBINS-I. The primary outcome was the risk of recurrence presented as a risk ratio (RR) with 95% CI. Secondary outcomes included adhesive small bowel obstruction, scoliosis, and survival to discharge. Meta-analytic estimates were calculated with a random-effects model. RESULTS: Six retrospective cohort studies involving a total of 300 patients were included for meta-analysis. Meta-analysis suggested that muscle flap repair significantly reduced the risk for recurrence after repair of CDH compared to patch repair (RR, 0.30 (95% CI, 0.15 to 0.63), I2 = 0%). The finding remained robust after a sensitivity analysis excluding critically biased studies. Meta-analyses did not find any significant differences between muscle flap and patch repair for the secondary outcomes of small bowel obstruction (RR, 1.77 (95% CI, 0.56 to 5.56), I2 = 0%), scoliosis (RR, 1.54 (95% CI, 0.57 to 4.13), I2 = 0%), and survival to discharge (RR, 1.07 (95% CI 0.84 to 1.38), I2 = 0%). CONCLUSIONS: Our findings demonstrate that neonates with CDH undergoing muscle flap repair have a 70% decreased risk of recurrence compared to patch repair. Secondary analyses did not show statistically significant differences between the two groups.