Response to ‘Re: Bochdalek hernias in adult population: a systematic review of the literature’

We would like to thank Koliakos et al. for their precise remarks on our article entitled ‘Bochdalek hernias in the adult population: a systematic review of the literature’. Their comments highlight the importance of current advancements on surgical technique, available technology, and their undoubtable impact on the management of Bochdalek hernias (BHs). Stratifying collected data from our systematic review into two categories, based on publication date (prevs. post-2012), reveals current trends on surgical management of BHs and their postoperative outcomes, as shown in Table 1. Minimally invasive techniques were preferred in the majority of cases published after 2012 (53.5%), in contrast to the previous period, where open surgical approach was mainly utilized (62.2%). Furthermore, there is an evident trend for mesh utilization over primary suture closure after 2012, but this finding did not reach statistically significant results. Postoperative morbidity and mortality rates and length of postoperative stay did not differ either between the periods in question. Additionally, regarding specifically the emergency cases of BHs, interesting conclusions are reached. There is a statistically significant swift towards minimally invasive techniques (OR: 3.91; 95% CI: 1.20–12.75), as the open surgical approach rates dropped significantly from 81.5% to 52.9% for preand post-2012 studies respectively. Furthermore, the utilization of either abdominal or thoracic approach did not differ significantly among emergent cases, which also applies to post-operative morbidity and mortality rates and length of hospital stay.