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

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 +/- 17.0min) 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.