Our Summary

This research paper is comparing two methods of repairing a birth defect known as a congenital diaphragmatic hernia, where there’s a hole in the diaphragm. The traditional method is open surgery, which is used in about 91% of cases. The other method is minimally invasive surgery (MIS), which involves smaller incisions and specialized tools.

The researchers looked at medical studies published between 2004 and 2022. They compared several factors, including how often the hernia came back, how long the surgery and hospital stay lasted, whether a patch was needed to repair the diaphragm, the death rate, and the use of a machine (extracorporeal membrane oxygenation or ECMO) to help with breathing after surgery.

They found that the minimally invasive surgery had several advantages over the open surgery. Patients who had the MIS method had shorter hospital stays, lower death rates, and less need for the breathing machine after surgery. There was also less need for a patch to repair the diaphragm. However, the hernia was more likely to come back in patients who had MIS compared to those who had open surgery.

The study suggests that more research is needed, ideally large-scale studies involving multiple centers, to determine which method is truly the best.

FAQs

  1. What is a congenital diaphragmatic hernia and how is it traditionally repaired?
  2. What are the advantages and disadvantages of minimally invasive surgery (MIS) compared to open surgery for repairing a congenital diaphragmatic hernia?
  3. What further research is suggested to determine the best method for congenital diaphragmatic hernia repair?

Doctor’s Tip

A doctor might tell a patient that minimally invasive surgery for congenital diaphragmatic hernia repair has several advantages, such as shorter hospital stays, lower death rates, and less need for a breathing machine after surgery. However, there may be a higher risk of the hernia coming back compared to traditional open surgery. It’s important for patients to discuss with their doctor the pros and cons of each method to determine the best approach for their individual case.

Suitable For

Typically, patients with congenital diaphragmatic hernia who are recommended for repair surgery are infants or young children who are experiencing symptoms such as difficulty breathing, respiratory distress, and digestive issues. In severe cases, the hernia can lead to life-threatening complications, making surgical repair necessary. The decision to recommend surgery is made by a multidisciplinary team of healthcare professionals, including pediatric surgeons, neonatologists, and respiratory therapists, based on the severity of the hernia and the overall health of the patient.

Timeline

  • Before surgery:
  1. Patient is diagnosed with congenital diaphragmatic hernia through ultrasound or other imaging tests during pregnancy.
  2. Patient may undergo fetal intervention if severe symptoms are present before birth.
  3. After birth, patient may experience difficulty breathing, feeding problems, and other symptoms related to the hernia.
  4. Patient may be stabilized with oxygen therapy, medications, and other treatments before surgery.
  • During surgery:
  1. Open surgery: Patient undergoes traditional open surgery to repair the diaphragmatic hernia, which involves a larger incision and direct repair of the hole in the diaphragm.
  2. Minimally invasive surgery: Patient undergoes MIS, which involves smaller incisions and specialized tools to repair the hernia.
  • After surgery:
  1. Patient recovers in the hospital, with monitoring of vital signs, pain management, and physical therapy.
  2. Open surgery: Patient may have a longer hospital stay, higher risk of needing ECMO for breathing support, and higher risk of needing a patch to repair the diaphragm.
  3. Minimally invasive surgery: Patient may have a shorter hospital stay, lower risk of needing ECMO, and lower risk of needing a patch to repair the diaphragm.
  4. Patient may require follow-up appointments and monitoring to ensure proper healing and to address any complications.

What to Ask Your Doctor

  1. What are the risks and benefits of open surgery versus minimally invasive surgery for repairing a congenital diaphragmatic hernia?
  2. How long does each type of surgery typically take to perform?
  3. How long is the hospital stay expected to be for each type of surgery?
  4. Are there any specific criteria that would make me a better candidate for one type of surgery over the other?
  5. What is the likelihood of the hernia recurring after each type of surgery?
  6. Will I need a patch to repair the diaphragm during the surgery?
  7. What is the mortality rate associated with each type of surgery?
  8. Will I need to be on a breathing machine (ECMO) after surgery, and if so, for how long?
  9. What is the long-term outlook for patients who undergo open surgery versus minimally invasive surgery for congenital diaphragmatic hernia repair?
  10. Are there any ongoing clinical trials or research studies comparing the outcomes of these two surgical methods for congenital diaphragmatic hernia repair?

Reference

Authors: Quigley CP, Folaranmi SE. Journal: J Laparoendosc Adv Surg Tech A. 2023 Feb;33(2):211-219. doi: 10.1089/lap.2022.0348. Epub 2022 Nov 23. PMID: 36445735