Systematic review
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Systematic review
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Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.
Systematic review
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Systematic review
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This article is included in 1 Structured summary of systematic reviews 51 Structured summaries of systematic reviews (1 reference)
This article includes 51 Primary studies 51 Primary studies (51 references)
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This article includes 6 Primary studies 6 Primary studies (6 references)
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Life-threatening congenital diaphragmatic hernia (CDH) is a defect with subsequent herniation of abdominal organs. Herniation of abdominal organs into the thoracic cavity causes pulmonary hypoplasia and hypertension. Despite improved baby critical care and surgical therapy, severe CDH has high mortality and morbidity rates. The prenatal intervention of fetoscopic endoluminal tracheal occlusion (FETO) has become popular for improving postnatal survival and lung development. However, its efficacy in reducing maternal risks, morbidity, and improving newborn survival is still debated. This systematic study compares FETO with expectant management of mothers on neonatal and maternal outcomes. A PICO-based systematic review was conducted. The study included fetuses with severe or moderate CDH. The intervention group had FETO, while the control group had expectant management with postnatal surgery. Neonatal survival, morbidity, and maternal problems were evaluated. A complete PubMed, OpenAlex, and CENTRAL search yielded 669 records. Forty papers met Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) eligibility criteria after deleting 154 duplicates, screening 515 abstracts, and analyzing 102 full-text articles. RCTs, cohort studies, and retrospective analyses were conducted. The data were extracted after title and abstract screening, followed by full-text screening using inclusion and exclusion criteria. Statistical analyses were then performed using RStudio (Posit PBC, Boston, MA, USA) to assess morbidity patterns, maternal risk factors, and pooled survival rates. Pooled analyses suggest that FETO may be associated with improved survival in severe CDH cases with liver herniation compared to expectant management. Some studies report noticeably higher survival rates with FETO, though others have shown the opposite trend, possibly reflecting differences in patient selection criteria. FETO has also been associated with higher incidences of pulmonary hypertension, prolonged ventilatory support, and increased risk of gastrointestinal complications such as feeding difficulties, gastroesophageal reflux, and reherniation. The impact of FETO on extracorporeal membrane oxygenation requirements appears inconsistent across studies, with some indicating a reduced need and others reporting similar rates regardless of intervention. A notable concern with FETO is its association with increased risks of preterm premature rupture of membranes (PPROM) and preterm delivery. PPROM has been reported in nearly half of FETO cases, compared to lower rates in expectant management. Correspondingly, gestational age at delivery tends to be earlier in FETO pregnancies, potentially contributing to lower birth weights and higher rates of neonatal intensive care unit admission. Serious maternal complications, such as hemorrhage, sepsis, or organ injury, are infrequently reported. FETO improves survival in severe CDH cases; however, this systematic analysis demonstrates that treatment increases neonatal morbidity and maternal morbidity. The findings highlight the importance of precise patient selection to maximize benefits and minimize risks. Clinically, FETO should be reserved for severe CDH cases in which the survival benefits outweigh the problems. Future research should focus on standardizing FETO procedures, enhancing postnatal care, and investigating other therapies to reduce PPROM and preterm birth risk.
Systematic review
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Systematic review
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