Objective:

To clarify the utilization rates of surgical techniques for right-sided Bochdalek hernias in both elective and emergency settings and present a management pathway.

Key Findings:

• Only 43% of cases reported the type of surgery performed, raising concerns about the reliability of the data.
• All emergency surgeries were performed via laparotomy, with most involving direct diaphragmatic suture.
• Laparoscopy was used in only 9% of non-emergency cases, indicating a potential gap in minimally invasive approaches.
• Most studies had moderate-to-low methodological quality, which may affect the generalizability of the findings.

Interpretation:

The decision between open and laparoscopic surgery depends on patient condition and surgeon experience, with no definitive guidelines established, highlighting the need for further research.

Limitations:

• Insufficient data on the necessity of emergency surgery limits the ability to draw firm conclusions.
• Variability in definitions of complicated hernias and surgical expertise may lead to inconsistent interpretations of the data.

Conclusion:

A management pathway was formulated emphasizing quick diagnosis, urgent repair of complicated hernias, and the critical need for long-term follow-up to ensure patient outcomes.