Abstract
Traumatic diaphragmatic hernia (TDH) occurs when abdominal contents herniate into the thoracic cavity, as the diaphragm is particularly susceptible to blunt or penetrating trauma. Currently, the standard treatments for TDH include minimally invasive surgical repair (MISR) and open surgical repair (OSR). MISR offers advantages such as reduced mortality, shorter hospital stays, and decreased postoperative pain and complications. In contrast, OSR is preferred for complex cases requiring better visualization, such as large defect repairs and comprehensive abdominal exploration. This study compares the clinical outcomes of MISR and OSR for TDH in adults, analyzing variables such as hospital stay, complications, recurrence rates, and postoperative pain. Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses or PRISMA guidelines, this systematic review was conducted across six online databases (PubMed, Embase, Scopus, Cochrane, Web of Science, and Google Scholar), screening 1,894 studies. Six comparative studies were included in the final analysis, comprising 8,990 patients (7,735 MISR; 1,255 OSR). Postoperative pain was measured using the visual analog scale (0-10), while hospital stays and recurrence rates were extrapolated from patient charts and reported as percentages. The results indicate that MISR offers potential benefits, including shorter hospital stays and fewer complications. Additionally, reduction in respiratory failure and postoperative pneumonia suggests improved hospital course with the minimally invasive approach. Comparable recurrence rates between techniques demonstrate that MISR achieves technical success similar to OSR when appropriately selected, with fewer complications and shorter hospital stays. In conclusion, MISR for TDH resulted in shorter hospital stays with fewer complications and had recurrence rates similar to OSR. However, variability in outcome reporting limits the clinical applicability of these conclusions and calls for further standardized studies.