Open Versus Minimally Invasive Surgery for Congenital Diaphragmatic Hernia Repair: A Systematic Review and Meta-analysis.

INTRODUCTION

Surgical repair remains the cornerstone of treatment for congenital diaphragmatic hernia (CDH), with open surgery (OS) and minimally invasive surgery (MIS) as the primary approaches. This study aims to comprehensively evaluate the safety and efficacy of OS versus MIS repairs in the management of pediatric patients with CDH.

MATERIALS AND

METHODS

PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched from inception to August 2025. A random-effects model was used for the analysis. The review was registered prospectively with PROSPERO (CRD42024536718).

RESULTS

Thirty studies meeting the eligibility criteria were included, comprising 6355 patients who underwent OS (n = 5557) or MIS (n = 798). OS was associated with a lower recurrence rate (odds ratio [OR]: 2.09, 95% confidence interval [CI]: 1.49, 2.95, I2 = 0%) and shorter operative time (mean difference: 26.8 min, 95% CI: 8.8, 44.7, I2 = 97%). However, MIS was associated with lower overall morbidity (OR: 0.51, 95% CI: 0.37, 0.72, I2 = 9%), lower mortality (OR: 0.20, 95% CI: 0.11, 0.34, I2 = 0%), and shorter hospital stay (mean difference: -4.5 d, 95% CI: -7.6, -1.3, I2 = 93%) than OS.

CONCLUSIONS

Despite having higher recurrence rates, MIS may be considered in pediatric patients, although optimal patient selection remains undefined. Further studies evaluating stratification based on CDH severity and associated comorbidities are needed to optimize patient selection criteria.