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Surgical approaches for neonatal congenital diaphragmatic hernia: a systematic review and meta-analysis

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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.

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Acknowledgments

This work was supported by a grant from the Ministry of Health, Labour and Welfare of Japan (Health and Labour Sciences Research Grants for Research on Intractable Diseases).

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8677, Japan

    Keita Terui & Hideo Yoshida

  2. Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan

    Kouji Nagata & Tomoaki Taguchi

  3. Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

    Miharu Ito & Masahiro Hayakawa

  4. Department of Pediatric Surgery, Shizuoka Children’s Hospital, Shizuoka, Japan

    Masaya Yamoto & Naoto Urushihara

  5. Osaka University Library, Osaka, Japan

    Masayuki Shiraishi

  6. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Hiroomi Okuyama

  7. Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Kouji Masumoto

  8. Department of General Surgery, National Center for Child Health and Development, Tokyo, Japan

    Yutaka Kanamori

  9. Division of Neonatology, Department of Maternal and Perinatal Medicine, National Center for Child Health and Development, Tokyo, Japan

    Keiji Goishi

  10. Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Japan

    Motoyoshi Kawataki

  11. Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

    Noboru Inamura

  12. Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Osamu Kimura

  13. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan

    Tadaharu Okazaki

  14. Section of Neonatology, Kanagawa Children’s Medical Center, Yokohama, Japan

    Katsuaki Toyoshima

  15. Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

    Noriaki Usui

Authors
  1. Keita Terui
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  2. Kouji Nagata
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  3. Miharu Ito
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  4. Masaya Yamoto
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  5. Masayuki Shiraishi
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  6. Tomoaki Taguchi
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  7. Masahiro Hayakawa
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  8. Hiroomi Okuyama
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  9. Hideo Yoshida
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  10. Kouji Masumoto
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  11. Yutaka Kanamori
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  12. Keiji Goishi
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  13. Naoto Urushihara
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  14. Motoyoshi Kawataki
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  15. Noboru Inamura
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  16. Osamu Kimura
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  17. Tadaharu Okazaki
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  18. Katsuaki Toyoshima
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  19. Noriaki Usui
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Corresponding author

Correspondence to Keita Terui.

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The authors declare that they have no conflict of interest.

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Terui, K., Nagata, K., Ito, M. et al. Surgical approaches for neonatal congenital diaphragmatic hernia: a systematic review and meta-analysis. Pediatr Surg Int 31, 891–897 (2015). https://doi.org/10.1007/s00383-015-3765-1

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  • DOI: https://doi.org/10.1007/s00383-015-3765-1

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