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Laparoscopic Repair of a Morgagni Hernia: Report of a Case and Review of the Literature
Abstract
A case is reported of an 85-year-old woman with subacute intestinal obstruction due to a large Morgagni hernia containing the transverse colon. The repair was carried out laparoscopically without a mesh. The procedure lasted 45 min, and the patient was discharged after 4 days. According to the literature, mini-invasive repair of a Morgagni hernia can be performed easily and without complications. In only few cases was a mesh necessary. The Morgagni hernia must be considered a clear indication for laparoscopic surgery, which should be offered as the first approach to this disease.
... After the reduction of the herniated abdominal viscera, performing resection of the sac or not is an aspect that is still controversial. There are authors, such as Contini et al., who describe [11] that in cases of the preservation of the sac, small residual thoracic cysts form, for which reason in these cases, they recommend leaving drainage in the thoracic cavity to minimise the phenomenon. On the other hand, some complications described after exeresis are pneumomediastinum or pneumothorax [1,5], like our patient presented. ...
... Regarding the type of mesh used, composite, expanded polytetra luoroethylene (ePTFE), or polypropylene are the available options [8]. Other authors recommend its use in all cases except for newborns [1,3,7,11,12]. We used simple raf ia without tension, and one year after the surgery, there has been no relapse. ...
... Both abdominal and thoracic laparoscopic approaches have also been described, although less frequently than the open one. As advantages, they offer a better view of the surgical ield, easy reduction of the hernia contents, the possibility of simple closing or the use of mesh, and the surgery is less aggressive, decreasing postoperative pain and the length of the hospital stay [2,3,7,8,9,11]. The post-operative complications described in the bibliography are: Atelectasis with serious respiratory insuf iciency, pneumothorax, pneumomediastinum, subcutaneous emphysema, CO2 embolism (in laparoscopic surgery techniques) and reappearance of the hernia, among others. With very low morbidity and mortality [1,3,4,9]. ...
... It was first described by Giovani Morgagni in 1769 and has unique features in terms of clinical presentation and associated anomalies (3,4) . Morgagni hernia is a rare condition, accounting for less than 6% of all surgically treated diaphragmatic hernias in the pediatric population (5,6) . It is often asymptomatic and discovered incidentally (6,7) . ...
... Morgagni hernia is a rare congenital diaphragmatic defect, accounting for less than 6% of pediatric diaphrag-matic hernias (5,6) . Our 20-year study evaluated 55 patients who underwent laparoscopic repair of MH. ...
Abstract
Objective. Morgagni hernia (MH) is a congenital diaphragmatic
defect located in the retrosternal region. This study aims to report and analyze 20 years of experience in the diagnosis and management of MH at a tertiary pediatric center.
Material and methods. We conducted a retrospective review of patients who underwent laparoscopic MH repair between 2002 and 2022. Data on symptoms, defect location, surgical techniques, complications, and recurrences were analyzed.
Results. Fifty-five children were included in the study. Thir- ty-two (58%) were male. Mean age at surgery was 36 months (3 days-11 years). Mean follow-up was 45.16 months (8-110 months). Most hernias were discovered incidentally (61.8%). Nineteen pa- tients (34.6%) had upper respiratory tract symptoms and a history of recurrent lung infection. Two patients (3.6%) presented with intes- tinal occlusion. Fifteen patients (27.2%) had Down syndrome, and seven (12.7%) had cardiac defects. The repair technique involved transabdominal laparoscopic-assisted repair with percutaneous su- tures and extracorporeal knotting. Reoperation due to recurrence was necessary in two patients (3.6%), one of whom needed two redo procedures.
Conclusions. The transabdominal laparoscopic-assisted tech- nique with percutaneous sutures and extracorporeal knotting is ef- fective for MH repair, offering a low recurrence rate and minimal complications. Emphasizing the technical aspects, including tips and tricks, may further benefit the readership.
Key Words: Hernias, diaphragmatic, congenital; Morgagni hernia; Minimally invasive surgical procedures.
... The resection of the hernia sac is not imperative. The postoperative course is usually uneventful and recurrence is rare [3,4]. The defect in the diaphragm is generally located on the right side (90%) or bilaterally (7%); occasionally it may be on the left side, although the presence of both heart and pericardium are a barrier against herniation [3,4]. ...
... The postoperative course is usually uneventful and recurrence is rare [3,4]. The defect in the diaphragm is generally located on the right side (90%) or bilaterally (7%); occasionally it may be on the left side, although the presence of both heart and pericardium are a barrier against herniation [3,4]. Most In our case she was present early as respiratory symptoms although the investigation was done and repeated many times but was difficult to detect the defect. ...
... It is one of the four possible congenital diaphragmatic herniae (CDH) accounting for 1-9% of them. The four types of CDH include Bochdalek hernia, Morgagni hernia, diaphragm eventration, and central tendon defects of the diaphragm [4,5]. CDH can be symptomatic or be diagnosed incidentally. ...
... Morgagni hernia is the rarest of all CDH, presenting mostly in childhood [4,5]. There are some reports documenting its presentation in adulthood [7][8][9][10]. ...
Introduction and importance
Morgagni Hernia is a congenital diaphragmatic hernia but can rarely present in adults. It occurs due to a congenital defect in the development of the diaphragm. Here we present a case of symptomatic Morgagni hernia diagnosed in a 53 years' female.
Case presentation
A 53 years' female presented with recurrent chest symptoms and was found to have bowel contents herniated into the right hemithorax on chest X-ray and CECT. Reduction of hernia was done laparoscopically and the hernia was repaired with non-absorbable suture in an interrupted manner.
Clinical discussion
Morgagni hernias are mostly diagnosed incidentally on a chest radiograph or can present with cardiorespiratory or abdominal symptoms. Our case was an adult who was diagnosed to have Morgagni hernia presenting with chest symptoms. The investigation of choice to diagnose and evaluate this condition is CECT of chest and repair of hernia without the use mesh is advised in asymptomatic cases also due to feared complications like strangulation and incarceration.
Conclusion
The treatment of Morgagni Hernia is primary surgical repair which can be done either transthoracically or transabdominally. It is advised that surgical repair should be done even in asymptomatic cases.
... 96 Minimally invasive repair allows the surgeon the advantage of ruling out uncertain diagnoses while still providing excellent view to the hernia as well as the contralateral hemidiaphragm, causing minimal tissue trauma, and providing superior cosmesis postoperatively compared with open techniques. 10,97,98 There are few limitations to attempting this approach, and surgeons often report that the technique is technically easy to learn and perform. 97 When present, laparoscopy also allows the straightforward takedown of adhesions between the viscera and the omentum under direct view. ...
... 10,97,98 There are few limitations to attempting this approach, and surgeons often report that the technique is technically easy to learn and perform. 97 When present, laparoscopy also allows the straightforward takedown of adhesions between the viscera and the omentum under direct view. This approach carries the shortest recovery time, offering almost immediate return to normal activities and diet by 3 days and with a complication rate as low as 5%. ...
Anteromedial subcostosternal defects, also known as a diaphragmatic hernia of Morgagni (MH), allow potentially life-threatening herniation of the abdominal organs into the thorax. Constituting only a small fraction of all types of congenital diaphragmatic hernias, correct diagnosis of MH is often delayed, owing in large part to nonspecific associated respiratory and gastrointestinal complaints. Once identified, the primary management for both symptomatic and incidentally discovered asymptomatic cases of MH are surgical correction because the herniated contents present increasing risk for strangulation. Various thoracic and abdominal surgical approaches have been described without a clear consensus on preference for operative repair technique. In this article, the literature regarding management of MH within the past decade is reviewed, and an illustrative case of laparoscopic repair of a MH with novel reinforcement using a Falciform ligament onlay flap is presented.
... There are four different types: (1) anterolateral hernia; (2) posterolateral or Bochdalek hernia; (3) pars sternalis; and (4) anteromedial or Morgagni hernia. The latter is the least common variety, accounting for only 1-3% of all [1]. The foramen of Morgagni is a space in the retroxiphoid sternocostal hiatus through which herniation of omentum, colon, stomach, or other viscera may occur [2]. ...
... A 55-year-old female of Aryan ethnicity had a history of vague epigastric pain more after taking meals for last 1 year. An ultrasound of the abdomen showed the presence of cholelithiasis. ...
Morgagni hernia is a rare type of diaphragmatic hernia. Though in the past, it has been dealt with an open approach, nowadays laparoscopic management is a favored approach. However, there are few controversies in this scenario.
We present here two females of Aryan ethnicity, one 55 and another 45 years old, who presented with pain at upper abdomen and retrosternal chest pain; on investigations were found to have cholelithiasis along with Morgagni hernia which were managed via the laparoscopic approach in the same sitting.
Repair of Morgagni hernia also via the minimally invasive technique can be offered to the patients like that for cholelithiasis.
... In the literature, the majority of authors have decided not to remove the sac, 2 but the debate is still open: some authors emphasize the risk of the formation of a cystic space because of the fluid produced by the sac remaining in situ, and they recommend positioning a drain. 6 However, it has been shown that the residual cavity may be obliterated spontaneously. We did not resect the sac because of the risk of pericardial injury. ...
... In the literature, in 14 of 24 cases, mesh was utilized to close the lacuna. 1,[6][7][8][9][10] There are also some cases in which the defect was large, and the closure was done only with stitches. We did not use mesh although the hole was large. ...
We report the case of a 2-year-old boy affected by a Morgagni-Larrey hernia discovered accidentally.
The hernia was large, and it contained an accessory hepatic lobe. The repair was
performed easily utilizing a laparoscopic approach. On the basis of our experience, we can
affirm that laparoscopic correction of Morgagni-Larrey hernia is not a difficult operation.
In our opinion, the minimally invasive procedure may be the first-choice treatment for this
kind of diaphragmatic defect
... Laparoscopic repairs have appeared in several reports both primarily and with the use of a patch. 2,[14][15][16][17][18][19][20] There have been reports of thoracoscopic repair of Morgagni hernias. 5,21 The disadvantages of thoracoscopy for these defects include the potential for chest tube drainage and the fact that many anteromedial defects will require mediastinal dissection to observe the entire defect, which is readily seen with laparoscopy. ...
... Morgagni hernias commonly have structures present within the hernia sac that are found intraoperatively and have been reported, noting the colon within the hernia sac (80%), omentum (13%), either small intestine or stomach (5%), and 3% had either liver, round ligament, or the falciform ligament contained within the sac. 6,8,12,14,15,[25][26][27] We found that insufflation reduced the herniated organs in every nearly case representing another advantage of laparoscopy. ...
Morgagni hernias are anteromedial diaphragmatic defects that are typically simple to repair. As opposed to posterolateral defects, which are very difficult to expose laparoscopically, the anterior defects can be easily seen with this approach. We reviewed our experience with laparoscopic and open repair of Morgagni hernias in children and their associated outcomes.
A retrospective review was conducted on all patients who underwent repair of Morgagni hernia from January 1994 to May 2009.
Seventeen patients were identified, of whom 9 underwent laparoscopic repair and 8 underwent an open repair. The mean age at operation was 3 years (newborn to 14 years) with a mean weight of 20.7 kg (3.6-87.6 kg). Intraoperatively, the diaphragmatic defect size in maximal dimension ranged from 3 to 11 cm. There was no difference in the average age, weight, and defect size among both groups. Of those who underwent laparoscopic hernia repair, 5 patients were closed with a Surgisis-Gold (SIS) patch, 1 was closed primarily with interrupted sutures, and 3 were closed with transabdominal sutures. In the open group, 7 were closed primarily and 1 required SIS patch for closure. Mean length of stay was 3.0 ± 1.5 days in the open group compared with 1.1 ± 0.4 days in the laparoscopic group (P < 0.01). There were no intraoperative complications and no recurrences.
Laparoscopic repair of Morgagni hernias is a relatively simple and effective method of repair in children with accentuated advantages of minimally invasive surgery.
... Tehnicile minim invazive necesită însă o selecţie atentă a pacienţilor şi o colaborare bună între chirurg şi anestezist. Corecţia laparoscopică a defectelor diafragmatice nu este dificil de realizat, exceptând cazurile în care sunt prezente aderenţe importante [10]. Este bine tolerată de pacienţi şi dă rezultate cosmetice excelente. ...
... La nici unul din cele două cazuri nu am practicat rezecţia sacului herniar. Unii autori susţin că rezecţia sacului herniar este parte componentă a intervenţiei chirurgicale în repararea defectului diafragmatic, recomandând rezecţia sau măcar plicaturarea acestuia, pentru a preveni formarea unei colecţii în cavitatea restantă sau recurenţa herniei [10]. Alţi autori, însă, afirmă că nu există nicio diferenţă în ceea ce priveşte evoluţia postoperatorie a pacienţilor la care s-a practicat rezecţia sacului herniar comparativ cu cei la care nu s-a efectuat [11]. ...
The retrosternal hernia is a rather rare affection encountered in the pediatric population, having an incidence of 1-6% of all the diaphragmatic hernias. It is generally asymptomatic, but it may present with respiratory or gastrointestinal symptoms. We present two patients with retrosternal hernia admitted with respiratory (recurrent repiratory infections before presentation) and gastrointestinal symptoms, respectively (weight stagnation for about four months and regurgitations). The final diagnosis was established on examining the colon appearance, after performing a barium enema, which in both cases revealed the intrathoracic, transdiaphragmatic and retrosternal colon herniation. Surgery was performed immediately after diagnosis, consisting in a median laparotomy with closure of the diaphragmatic gap with separate stitches, without having the hernia sac resected. The patients were discharged on the eighth postoperative day and on the fourth one, respectively. The clinical and X-ray controls performed one month after surgery revealed good results. When dealing with retrosternal hernias in children, surgery must be performed in order to close the diaphragmatic gap as soon as the diagnosis is certain, because of the high risk of complications. Even the resection of the hernia sac was not performed in any of the two presented cases, the long-term follow-up showed a favourable course.
... Morgagni hernia is the rarest form of diaphragmatic hernia (Contini et al., 1999). The hernia defect is formed because of failure of (Table 19). ...
The aim of this study was to evaluate our series of thoracoscopic repairs regarding initial results and preference of this approach in repair of congenital diaphragmatic hernia (CDH) in pediatric age.
Congenital diaphragmatic hernia is a complex congenital anomaly that consists of incomplete formation of the diaphragm coupled with herniation of the abdominal viscera into the chest that results in some degree of pulmonary hypoplasia in the ipsilateral lung and to a lesser extent in the contralateral lung. Bochdalek hernia is the most common hernia type of CDH (95%), while Morgagni hernia has an incidence of about 2%. Bochdalek hernias usually present immediately after birth with respiratory distress while late-presenting hernias represent about 5-20% of cases and are characterized by mild-to-moderate symptoms with a relatively stable general condition. Morgagni hernias are usually diagnosed late due to non-specific nature of symptoms with very few cases detected and managed in the neonatal period. Following a period of preoperative stabilization and optimization; patients with CDH are traditionally repaired surgically via a laparotomy or thoracotomy. Recently, MIS had been applied in the field of CDH utilizing both laparoscopic and thoracoscopic techniques. In the current study, 27 patients with CDH had been treated surgically by Thoracoscopic approach, were divided into 3 groups: Group (1): included infants with late-presenting Bochdalek hernia (N.˚ 8) that were managed by thoracoscopic technique. Group (2) included cases with neonatal presentation of Bochdalek hernia (N.˚ 15) and managed by thoracoscopic technique.
Group (3) included cases with Morgagni hernia (N.˚ 4) that failed repaired by thoracoscope and were repaired by the laparoscopic and open techniques. The study had shown easiness and feasibility of the thoracoscopic route. Thoracoscopic route is much more preferable in treating Bochdalek hernia in infants and children because of easy reduction of hernia contents, short operative time, low conversion rate, short time to reach full enteral feeding, short hospital stay and low rate of complications and recurrences. The same results have been obtained in group (2) patients with neonatal presentation of Bochdalek hernia, provided that the strict exclusion criteria have been followed; thus minimizing the complications and improving the outcome of thoracoscopic route. Group (3) patients have shown that Morgagni hernia was difficult to deal with thoracospically due to position of the defect, position of the pericardium, difficult angulations of instruments, and the laparoscopic repair of Morgagni hernia is a very safe and effective tool in treating such anomaly. Thus, we come into conclusion that the thoracoscopic repair of Bochdalek hernia is much preferable route in both neonates with strict exclusion criteria and also in infants and children. Furthermore, the laparoscopic route is the standard route for repair of Morgagni hernia. The rapid advancement in laparoscopic instrumentation and optics as well as the training programs; will gradually minimize the exclusion criteria adopted in neonates with severe cardio-respiratory imbalance and so expanding the application of MIS in such group of patients.
... M orgagni hernias are rare finding in the adult population and represent 1%-3% of all congenital diaphragmatic hernias. [1] These retrosternal diaphragmatic hernias develop from a congenital failure of the pars sterna to fuse with the costal arches. Most commonly, these hernias occur on the right; however, rarely, they can occur on the left, termed a Morgagni-Larrey hernia. ...
Morgagni hernias are a rare finding in the adult population and represent 1%–3% of all congenital diaphragmatic hernias. Multiple approaches to these rare hernias have been described in the literature. Here, we present a novel technique of laparoscopic transabdominal repair using a combination of the Endo-Close device (Medtronic, Minneapolis, MN, USA) and the Ti-KNOT (LSI Solutions, Victor, NY, USA). In a patient with a large left anterior diaphragmatic defect, we performed transabdominal suturing utilizing the Endo-Close to perform primary closure of the defect, using the Ti-KNOT to secure the pledged sutures along the anterior fascia. Due to the size of the defect (7 cm × 10 cm), this primary repair was buttressed with polyester mesh. In a second patient with a smaller (6 cm × 8 cm) classic right-sided anterior diaphragmatic defect, we similarly performed laparoscopic transabdominal suturing using the Endo-Close to traverse both the anterior and posterior fascia and the Ti-KNOT to secure the sutures to perform a primary repair of the hernia. Both patients presented had an uneventful postoperative course and no indication of recurrence at 4 months. Morgagni hernias present unique technical challenges. In our experience, the combined use of transabdominal suture with laparoscopic knot placement device allowed for completion of both cases laparoscopically with minimal tension on the repairs.
... Since the first successful laparoscopic repair of Morgagni hernia was reported in 1992, there has been a boom of various interpretation of the approach with each technique having its own set of advantages and disadvantages[9]. Laparoscopic approach provides better vision, cosmesis with quicker recuperation time as compared to an open approach for the repair of a Morgagni and ventral Hernia[10,11]. The rarity of this clinical entity prevents a common consensus statement to be developed with regards to the best laparoscopic technique that should be applied. ...
CITATION: [Kosai, N. R., Reynu, R., Gendeh, H. S., Das, S., & Lakdawala, M. (2016). Concurrent mesh repair of a Morgagni and umbilical hernia during a laparoscopic sleeve gastrectomy in a morbidly obese individual. Journal of Krishna Institute of Medical Sciences University, 5(4), 87-92]
Morgagni Hernia is a rare form of diaphragmatic hernia. It is mainly asymptomatic and often identified incidentally during surgery. Tension-free synthetic mesh repair is the preferred treatment modality. However, the use of synthetic mesh concurrently during a clean-contaminated surgery such as sleeve gastrectomy remains controversial due to the remote possibility of mesh infection. A middle-aged female 2 with BMI of 47 Kg/m was admitted electively for laparoscopic sleeve gastrectomy with concurrent umbilical hernia repair. Intra-operatively, a left Morgagni Hernia containing omentum and a segment of transverse colon was noted. She underwent a laparoscopic sleeve gastrectomy and simultaneous laparoscopic tension-free composite mesh repair of both Morgagni and umbilical hernia. Outpatient review three months later revealed excess weight loss of almost 30% with no recurrence of either hernia. In conclusion, the advantages of concurrent hernia repair during bariatric surgery outweigh the risk of mesh infection and should be performed to prevent future risk of visceral herniation and strangulation. Laparoscopic mesh repair of a Morgagni Hernia and umbilical hernia in the setting of an electively planned sleeve gastrectomy is feasible, effective and safe in the hands of a trained laparoscopic surgeon.
... Regarding the repair technique, there is still a debate whether primary closure or mesh repair produce the best results. 15 However larger defects need mesh repair. 8 We repaired most of the defects primarily and used mesh when the defect was considerably of large size. ...
p> Introduction : Diaphragmatic hernia and eventration are amongst the less commonly encountered thoracic surgical problems in Nepal. Unlike, the cases of traumatic herniation, adults with congenital hermination and eventration seek medical attention very late.
Methods : It is a retrospective observational study of patients presenting with diaphragmatic hermiation and eventration at Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal. Medical records of five years (May, 2010 to April, 2015) were reviewed. Analysis of the demographic profile, clinical features, management and outcome was done.
Results : There were a total of 15 patients who were diagnosed to have diaphragmatic hermiation and eventration. There were eight cases of hermiation and seven cases of eventration. There were three cases of acute diaphragmatic hermiation. Thoracic trauma was found to be associated in three cases of herniation only. The mean age at presentation was 46.5 years. Thoracic trauma was seen in Younger age (mean age being 34 yrs). There were two cases of morgagni hernia and one of these was diagnosed incidentally. Mean duration of symptoms was two months. The most common presenting symptoms were shortness of breath and cough. Twelve cases were repaired via thoracotomy. Mean size of diaphragmatic defect was six centimeters. The most commonly herniated organ was stomach followed by momentum. Placation was the most commonly performed procedure in eventration and primary repair was done in six cases of hermiation and mesh repair in two cases. Only two patients had superficial surgical site infection. Mean duration of hospital stay was eight days. The patients were doing good up to mean follow up period of four months.
Conclusion : Diaphragmatic hermiation and eventration in symptomatic patients should be managed surgically. Surgical approaches can be thoracotomy, laparotomy and Video Assisted Thoracoscopic Surgery. Outcome following surgery is good with minimal postoperative complications.
JSSN 2015; 18 (1), Page : 1-4 </p
... Bochdalek hernia is the most common type of congenital diaphragmatic hernia. Anteromedial or Morgagni hernia is the least common variety, accounting for only 1-3% of all diaphragmatic hernias [1][2][3]. It is caused by a defect in the retrosternal region of the diaphragm and is considered to occur due to failure of fusion in the anterior part of the pleuroperitoneal membrane and deficiency in the process of muscularization [4]. ...
Introduction . Morgagni hernia is a rare form of congenital diaphragmatic hernia. Case Presentation . We present three cases of Morgagni hernia with GI symptoms treated by laparoscopic surgery. Discussion . Hernial sac was excised in two cases and left in situ in one case. There was no recurrence in symptoms after 30 months from surgery.
... Since the first successful laparoscopic repair of Morgagni hernia was reported in 1992, there has been a boom of various interpretation of the approach with each technique having its own set of advantages and disadvantages [9]. Laparoscopic approach provides better vision, cosmesis with quicker recuperation time as compared to an open approach for the repair of a Morgagni and ventral Hernia [10,11]. The rarity of this clinical entity prevents a common consensus statement to be developed with regards to the best laparoscopic technique that should be applied. ...
Morgagni Hernia is a rare form of diaphragmatic hernia. It is mainly asymptomatic and often identified incidentally during surgery. Tension-free synthetic mesh repair is the preferred treatment modality. However, the use of synthetic mesh concurrently during a clean-contaminated surgery such as sleeve gastrectomy remains controversial due to the remote possibility of mesh infection. A middle-aged female 2 with BMI of 47 Kg/m was admitted electively for laparoscopic sleeve gastrectomy with concurrent umbilical hernia repair. Intra-operatively, a left Morgagni Hernia containing omentum and a segment of transverse colon was noted. She underwent a laparoscopic sleeve gastrectomy and simultaneous laparoscopic tension-free composite mesh repair of both Morgagni and umbilical hernia. Outpatient review three months later revealed excess weight loss of almost 30% with no recurrence of either hernia. In conclusion, the advantages of concurrent hernia repair during bariatric surgery outweigh the risk of mesh infection and should be performed to prevent future risk of visceral herniation and strangulation. Laparoscopic mesh repair of a Morgagni Hernia and umbilical hernia in the setting of an electively planned sleeve gastrectomy is feasible, effective and safe in the hands of a trained laparoscopic surgeon.
... It was first described in the 1700s and is the least common type of diaphragmatic hernia, contributing only 1-6% of all diaphragmatic hernias. 1,2 Reported here is an interesting case of a central diaphragmatic hernia which could be a variant of Morgagni hernia presenting in a patient with history of shortness of breath and palpitation increased on lying down. ...
... The condition is often asymptomatic but it is often diagnosed incidentally during the investigation of other conditions. 4 Diagnosis needs a high index of suspicion as misdiagnosis and noncorrection may end in a catastrophe. 5 Standard surgical procedures for the repair of MH traditionally require a laparotomy or thoracotomy, but with the recent improvement in minimal invasive surgery instrument and vision, repair can safely be performed laparoscopically. ...
Purpose: Morgagni hernia (MH) is a rare entity that accounts for less than 6% of all surgically treated diaphragmatic hernias in pediatric age group. They are mostly asymptomatic and discovered incidentally. Open surgical repair has been the gold standard in all cases. However, since the introduction of minimal access surgery, different laparoscopic techniques of MH repair have been reported. Most of them are reporting on few cases and the immediate outcomes. I report one of the largest experiences to date assessing the safety and efficacy two trocars laparoscopic repair of MH in children with more emphasis on the short-term outcomes, such as the recurrence, conversion rate, operative, postoperative complications and the fate of the hernia sac. Patients and methods: Fifteen children with MHs underwent primary laparoscopic repair by placement of U-shaped, nonabsorbable sutures through the full thickness of the anterior abdominal wall incorporating, the posterior rim of the defect, and returning back out through the anterior abdominal wall with the sutures tied in the subcutaneous tissue using the Storz port closure needle and without hernia sac excision, no insertion of chest tube or drain. Results: A total of 15 patients with MH were operated upon. There were 10 males and 5 females. Left-sided MH was present in five cases (33%), right-sided MH was present in seven cases (47%) and three bilateral MH (20%). Male-female ratio was 2:1. Intraoperative and postoperative analgesia requirement was minimal. All operations were completed laparoscopically. None of the patients developed intraoperative or postoperative complications. The maximum follow-up was 48 months (mean, 20 months). All patients are in good health without recurrence or significant sac residual. Conclusion: This easy save technique of MH repair is reducing the operative time and postoperative hospital stay. Also it is minims the need of postoperative analgesia. The hernia sac excision or not is not affecting the outcome.
... Morgagni hernisi, diğer bir konjenital diyafram hernisi olan Bochdalek hernisinin aksine, genellikle bir fıtık kesesine sahiptir (20). Fıtık kesesi içinde genellikle omentum, kolonun çesitli kısımları ve mide bulunur (23). ...
... Ramachandran and Arora (23) reported that a hernia sac that was not excised was totally resolved one month postoperatively based on a CT control. CONTINI et al. (24) reported that small residual cysts were still present on a CT Downloaded by [Ataturk University] at 12:11 09 July 2016 examination. Hernia sacs were resected in all patients who underwent thoracotomy and the resection rate in the laparotomy and laparoscopy patients were 82% and 31%, respectively (3). ...
Background:
Morgagni hernias are rare and constitute less than 2% of all diaphragmatic hernias. Treatment is primarily surgical and transthoracic or transabdominal route approach methods are amenable. In this study, we compared the results of our Morgagni hernia cases, which underwent either transabdominal or transthoracic method of surgery.
Methods:
We retrospectively analyzed the records of 20 patients we operated on for Morgagni hernias between 1997 and 2011 in our clinic. Age, sex, presenting symptoms, lesion location, diagnoses, applied surgical method, duration of the hospital stay, morbidity and mortality rates were reviewed. Six of the cases were (30%) approached via thoracotomy and 14 (70%) were laparotomy. The hernial sac was resected in all cases. Diaphragmatic defects were repaired using nonabsorbable sutures in all cases except in one case where prolen mesh used.
Results:
Thirteen cases (65%) were female and seven (35%) were male. Mean age was 44.1 +/- 25.3 years (1-73 years). Hernias were located on the right side in 18 cases, the left side in one, and bilaterally located in one case. Herniated organs were: omentum in 19 (95%), transverse colon in 18 (90%), small bowel in 4 (20%), stomach in 3 (15%), and left lobe of the liver in one (5%) case. No complication was observed in patients who underwent laparotomy, and wound infection occurred in one patient who underwent thoracotomy. Hospital stays in thoracotomy and laparotomy groups are 7 and 6.2 days, respectively. There were no mortalities observed. There was no recurrence during the follow-up of 36.4 months (10-116 months).
Conclusion:
Our findings showed that both surgical methods have similar and satisfactory results. Although transthoracic approach was preferred in previous cases, the transabdominal approach was preferred in later ones because we assumed that the later procedure is less invasive for the patient. We prefer and propose the abdominal approach for the surgical management of Morgagni hernias.
... In our case after the standard right hemicolectomy was performed for the caecal volvulus the diaphragmatic hernia required repair. Consensus on whether synthetic mesh or primary closure produce the safest and most durable repair for diaphragmatic hernia has yet to be agreed [16] . The placement of synthetic mesh repair in close proximity to the esophagus runs the risk of erosion [17] . ...
An 85-year-old woman presented with sudden onset of generalised abdominal pain and absolute constipation for 4 d. On examination she had a distended abdomen. Plain abdominal radiograph revealed a gas filled viscous within the left upper quadrant. Subsequent computed tomography suggested caecal volvulus herniated through a left diaphragmatic hernia. The patient underwent reduction of the internal hernia, right hemicolectomy and mesh repair of the diaphragmatic hernia. Postoperative recovery was uneventful. Histology revealed a Dukes' A colonic cancer within the caecum. Herniation of caecal volvulus through a diaphragmatic hernia is a very rare condition and may have been precipitated by the colonic tumour.
... Table 2 summarises all published paediatric series of laparoscopic repair, excluding case reports. There was only one case of hernia recurrence which was attributed by the authors to the use of absorbable sutures [20]. We believe that our high incidence of recurrence may be partly due to an underestimation of the tension following the closure. ...
Purpose:
Morgagni diaphragmatic hernia can be repaired laparoscopically. The aim of this study is to evaluate the outcome of this minimally invasive approach.
Methods:
A retrospective review was conducted on all consecutive children who underwent repair of Morgagni hernia from January 2002 to December 2011 in our hospital. Data are expressed as median (range).
Results:
There were 12 children with Morgagni hernia. Age at surgery was 7.5 months (2-125). Associated malformations were present in 7 children (58 %). All children underwent initial laparoscopic approach. Two children (16 %) underwent conversion to open surgery. The hernia was closed primarily in 11 children (92 %), using a polyester patch in 1 (8 %). There were no intraoperative or immediate postoperative complications. Five children (42 %), all repaired initially without a patch, had a recurrence of the Morgagni hernia. The repair of the recurrent hernia was performed laparoscopically in four out of the five children, and a patch was used in two patients with no further recurrences or complications.
Conclusions:
There is a high rate of recurrence after laparoscopic Morgagni hernia repair. This is exclusively associated with laparoscopic repair without patch, and it is in contrast with the low recurrence rate reported previously. More frequent use of patch may be beneficial.
... There is controversy in the literature concerning the management of the hernial sac. Some authors recommend excision of the sac, [1,7] whereas others leave the sac in situ [8,9] without compromising the outcome. In the case described here, only the redundant sac was excised and the remainder of the sac was left in situ to avoid pleural or pericardial injury. ...
Laparoscopic repair of Morgagni hernia has been described in adults and children. In the published reports, the crux of the repair consists of suturing the posterior part of the diaphragmatic defect to the undersurface of the sternum or the posterior rectus sheath. The tissue on the undersurface of the sternum is variable is in its nature and may be inadequate for suturing, hence compromising the strength of the repair. A technique that circumvents this problem and offers a strong anatomical repair is described. A Morgagni hernia was diagnosed in a 2-year-old girl with trisomy 21, who presented with recurrent chest infections. She underwent laparoscopic repair of the hernia using three ports. The tissue on the undersurface of the sternum was inadequate for a conventional repair. The procedure was modified as follows: a small transverse incision was made over the lower end of the sternum. Three nonabsorbable mattress sutures were inserted through the sternum, the anterior edge of the diaphragmatic defect, and back through the sternum and tied with extracorporeal knots. The child was discharged home on the second postoperative day. At 6-month follow up, the child was asymptomatic, and had been infection free. A chest radiograph was normal. This is a simple, novel, noninvasive method, which offers a secure anatomical repair and it is not dependent on the adequacy of the tissue on the undersurface of the sternum.
... There is controversy in the literature concerning the management of the hernial sac. Some authors recommend excision of the sac, [1,7] whereas others leave the sac in situ [8,9] without compromising the outcome. In the case described here, only the redundant sac was excised and the remainder of the sac was left in situ to avoid pleural or pericardial injury. ...
Laparoscopic repair of Morgagni hernia has been described in adults and children. In the published reports, the crux of the repair consists of suturing the posterior part of the diaphragmatic defect to the undersurface of the sternum or the posterior rectus sheath. The tissue on the undersurface of the sternum is variable is in its nature and may be inadequate for suturing, hence compromising the strength of the repair. A technique that circumvents this problem and offers a strong anatomical repair is described. A Morgagni hernia was diagnosed in a 2-year-old girl with trisomy 21, who presented with recurrent chest infections. She underwent laparoscopic repair of the hernia using three ports. The tissue on the undersurface of the sternum was inadequate for a conventional repair. The procedure was modified as follows: a small transverse incision was made over the lower end of the sternum. Three nonabsorbable mattress sutures were inserted through the sternum, the anterior edge of the diaphragmatic defect, and back through the sternum and tied with extracorporeal knots. The child was discharged home on the second postoperative day. At 6-month follow up, the child was asymptomatic, and had been infection free. A chest radiograph was normal. This is a simple, novel, noninvasive method, which offers a secure anatomical repair and it is not dependent on the adequacy of the tissue on the undersurface of the sternum.
... It provides the benefit of an excellent view,m inimal tissue trauma with subsequently faster recovery and superior cosmesis. 5 Laparotomy,h owever,i ss till the most common approach for repair. 2,3 Although laparoscopyw as initially used in our case, early conversion to al aparotomy was undertaken as there was evidence of necrotic small and large bowel which was difficult to reduce. ...
We report an unusual case of strangulated diaphragmatic (Morgagni) hernia resulting in ischaemia of the small and large bowel, which was initially diagnosed as a pneumonia. This case highlights the importance of being aware of this rare, but potentially fatal condition when assessing patients with respiratory symptoms and abdominal pain.
Case report of a thoracic lipoma within a Morgagni's hernia
In this report, we present the clinical characteristics and surgical outcomes of three pediatric patients who presented to our clinic with congenital Morgagni hernia and were treated with laparoscopic surgery using only mesh.
Background:
Morgagni hernias present technical challenges. The laparoscopic approach for repair was first described in 1992; however, as these hernias are uncommon in adult life, few data exist on the optimal method for surgical management. The purpose of this study was to analyze a method for laparoscopic repair of Morgagni giant hernias using laparoscopic primary closure with V lock (Medtronic, Covidien).
Methods:
This case series describes a method of laparoscopic Morgagni hernia repair using primary closure. In all patients, a laparoscopic transabdominal approach was used. The content of the hernia was reduced into the abdomen, and the diaphragmatic defect was closed with a running laparoscopic suture using a self-fixating suture. Clips were placed at the edges of the suture to secure the pledged sutures to both the anterior and posterior fascia. Demographic data such as BMI and operative and postoperative data were collected.
Results:
Retrospectively collected data for 9 patients were analyzed. There were 1 (11.1%) males and 8 (88.8%) females. The median BMI was 29.14±52 kg/m2. The median operative time was 80±25 minutes. There were no intraoperative complications or conversions to open surgery. Patients began a fluid diet on the first postoperative day and were discharged after a median hospital stay of 3±1.87 days. In a median follow-up of 36 months, we did not observe any recurrences.
Conclusions:
Transabdominal laparoscopic approach with primary closure of the diaphragmatic defect is a viable approach for the repair of Morgagni hernia. In our experience, the use of laparoscopic transabdominal suture fixed to the fascia allowed the closure of the defect laparoscopically with minimal tension on the repairs.
Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.
A 78-year-old woman was admitted to another hospital with vomiting. Chest X-ray showed an abnormal shadow in the lower right lung field, and CT indicated a Morgagni hernia containing the stomach and transverse colon. The patient was transferred to our hospital and underwent laparoscopic surgery. After the hernia contents were repositioned into the abdominal cavity, we repaired the hernia orifice with a prosthetic mesh to achieve a tension-free repair. There were no complications after the surgery, and there has been no recurrence. The patient has remained free of clinical symptoms since 10 months after the surgery. Laparoscopic repair with a prosthetic mesh for Morgagni hernia is a simple and safety procedure for elderly patients.
© 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
Material and method
We reviewed repair of Morgagni’s hernia in three hospitals between 1980 and 2000.
Results
Data on 28 patients were collected. The male-to-female ratio was 12/16. The mean age was 45 ± 13.2 years (range: 7-83) in men and 51 ± 16.4 years (range: 18-85) in women. Findings were casual in 13 patients and symptomatic in 15: non-specific digestive symptoms in 8 patients, respiratory in 5 and cardiac in 2. The surgical approach was thoracic in 7 patients, abdominal in 19 and laparoscopic in 2. There were 6 recurrences (21.4%).
Conclusions
Morgagni’s hernias are infrequent. The risk of recurrence after traditional treatment is high. Most of these hernias are treated electively, using the abdominal approach.
Morgagni hernia is an uncommon type of diaphragmatic hernia, which usually presents in adulthood. Its treatment is mainly surgical.We present the case of a 65-year-old man with a giant Morgagni hernia with a 12 × 7 diaphragmatic defect. The hernia was repaired laparoscopically using an intra-abdominal bilaminar mesh. We review the present-day treatment of Morgagni hernia, in which laparoscopy is beginning to occupy a predominant position.
Purpose: Removal of the hernia sac for Morgagni diaphragmatic hernia repair in infants and children is a controversial issue. In our series, we elected not to excise the sac in all the cases.
Methods: Nine children with retrosternal (Morgagni) hernias underwent primary laparoscopic repair without excision of the hernia sac, and we analyzed our results, complications, and outcome.
Results: Between January 2007 and March 2011, nine children, comprising five boys and four girls, with Morgagni hernia underwent repair laparoscopically at our hospital. The mean age of the children was 15.1 months (range, 3–38 months), mean operative time was 50.5 min, and mean hospital stay was 3.6 days. There were no intraoperative or postoperative complications. The mean follow-up time was 32.8 months (range, 6–54 months). There were no recurrences. All patients had complete obliteration of the residual cavity.
Conclusion: Laparoscopic closure of the defect by suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall without excision of the hernia sac is safe and effective in repairing Morgagni hernia without any risk accruing from leaving the hernia sac intact.
Congenital Morgagni hernia is a rare clinical condition. We present a 72-year-old man with epigastric discomfort and hematemesis who was diagnosed with hernia of Morgagni with an incarceration of the stomach and colon. The patient was treated electively by laparoscopic composite-mesh repair without excising the hernial sac or approximating the edges of the defect, which was 10 × 6 cm in diameter. He was discharged on the seventh postoperative day without any complications. At a 1-year follow-up examination he had no recurrence nor clinical symptoms, although the large hernial sac contained fluid. Laparoscopic composite-mesh repair is a less-invasive and tension-free method for Morgagni hernia that results in an excellent clinical outcome.
Morgagni hernia is a rare entity that accounts for 3-5% of diaphragmatic hernias. They are mostly asymptomatic and discovered incidentally. Surgical treatment is indicated once diagnosis is made. Abdominal or thoracic accesses are possible using open or minimally invasive technique.
We report two cases of laparoscopic assisted repair of Morgagni hernia conducted by primary closure of the diaphragmatic defect with extracorporeal nonabsorbable sutures anchoring the diaphragmatic edge at the muscular fascia of the abdominal wall.
Both patients had an uneventful postoperative recovery. The operative time was 90 and 60 minutes and the postoperative hospitalization was 4 and 2 days respectively.
Laparoscopic intervention for Morgagni hernia repair is easy, safe and less invasive compared to the open one, with reduced hospitalization time. Primary closure of the diaphragmatic defect with extracorporeal nonabsorbable sutures is an effective technique for Morgagni hernia; defects larger than 20-30 cm2 should be repaired using a prosthetic patch.
Morgagni's hernia presents with acute complication of the hernia itself like bowel obstruction or strangulation, or respiratory symptoms. Open or laparoscopic, trans-abdominal, trans-thoracic or combined surgical techniques have been used for defect reparing. We report a case of a 73-year-old woman, presenting with respiratory symptoms, affected by a Morgagni's Hernia containing the whole omentum and with the initial involving of transverse colon, which determined severe impairment of respiratory function. The patient underwent a laparoscopic approach, the sac was explored and partially retracted in abdomen but no dissection was tempted. A not preformed polypropylene mesh was placed upon the defect with at least 3 cm of overlapping. The post operative course was uneventful, the patient was discharged on IV post operative day. The debate on the safest and most effective modality to repair this rare hernia is still on the way. Since Morgagni' s hernia is a rarity, every single surgeon approaches it on the basis of his own preferences, so we believe no evidence based surgery will ever be applied to this rare defect. We report our experience, the surgical strategy and a review the literature on the outlined topics.
The article discusses the presentation and treatment of foramen of Morgagni hernia. First, it describes the embryology of the diaphragm along with the incidence of associated anomalies. This is followed by the symptoms, diagnosis, and management. Morgagni hernias are rare and most often asymptomatic; however, there is always a concern about strangulated bowel. Diagnosis is usually by chest radiograph or CT scan. The surgical approach may be either transabdominal or thoracic. Experience is increasing with minimally invasive approaches, which has a low recurrence rate and an excellent prognosis.
Purpose:
Morgagni hernia is a rare entity that accounts for less than 6% of all surgically treated diaphragmatic hernias in pediatric age group. They are mostly asymptomatic and discovered incidentally. Open surgical repair has been the gold standard in all cases once diagnosed. However, since the introduction of minimal access surgery, different laparoscopic techniques of Morgagni hernia repair have been reported in the literatures. Most of them are reporting on few cases and the immediate outcomes. Herein, we report the largest experience to date assessing the safety and efficacy of laparoscopic-assisted full-thickness anterior abdominal wall repair of Morgagni hernia in children with more emphasis on the short-term outcomes, such as the recurrence and the fate of the hernia sac.
Methods:
Fifteen children with Morgagni hernias underwent primary laparoscopic repair by placement of interrupted nonabsorbable sutures through the full thickness of the anterior abdominal wall, incorporating the hernia sac, the posterior rim of the defect, and returning back out through the anterior abdominal wall with the sutures tied in the subcutaneous tissue.
Result:
Between January 2004 and January 2008, 15 children with Morgagni hernia were treated laparoscopically in our institution-affiliated hospitals. Male-female ratio was 2:1. Mean age was 21.7 months. The average operative time was 42.6 minutes. Average time to full feed was 22.9 hours. Postoperative analgesia requirement was minimal. The average hospital stay was 24 hours. All operations were completed laparoscopically. None of the patients developed intraoperative or postoperative complications. The maximum follow-up was 48 months (mean, 20 months). All patients are in good health without recurrence or significant sac residual.
Conclusion:
Laparoscopic-assisted Morgagni hernia repair is a safe and effective modality of treatment. It is well tolerated and gives all the advantages of minimal access surgery, without adverse effects from leaving the sac plicated in place.
Aim: We present the main results from a combined screening study for colorectal cancer carried out in an asymptomatic population from Iaşi, Romania, during 2004-2007, adopting a combination of faecal occult blood testing (FOBT) and full colonoscopy. The primary aim of the current study was to determine the location of polyps and cancers and the prevalence of advanced histologic features in colorectal lesions removed by polipectomy followed or not by surgery. Secondary aim was to determine whether there were any risk factors for advanced histology in each patient group. Material and methods: Overall, 1291 asymptomatic subjects were screened. Patients were divided into groups, based on age: 50-59 yr, 60-69 yr, and ≥70 years, which were statistically analyzed. Results: Using FOBT and full colonoscopy with polypectomy as combined screening tools we were able to identified 38 cases (2.94%) of polypoid lesions (non-neoplastic and neoplastic) and colorectal cancers. 1.85% subjects from all eligible subjects were found to have advanced neoplasia and 43.75% of them had advanced histology. Taking into consideration colorectal adenomas, there were a predominance of male subjects in 50-59 age group (31.25%), but their histology was not an advanced one. As age increases to ≥70 years old, the tendency is for women subjects with villous architecture with high-grade dysplasia to predominate (18.5%). Proximal site was associated with smaller size of neoplastic polyps (
The purpose of this research was made necessary by the progressive increase in costs for medical assistance, together with a decrease in the number of available hospital beds and therefore raising the necessity for a shorter stay in hospital and safe hospital discharge. Methods: This research is based on a study group of 206 patients, who had recently undergone total thyroidectomy surgery due to different pathologies (functional or non functional goiter, Basedow disease, differentiated carcinoma, medullar carcinoma). In order to discharge the patients safely within 24 hours after surgery, not well accepted by all the patients – the serum calcium level was postoperatively measured at regular intervals, after 6, 12 and 18 hours. We used the variance analysis of the 3 samples, utilizing the p-value to verify the possibility of reducing the necessary number of blood samples to two when calculating the risk factor of hypocalcemia. Conclusion: We can consider the evaluation of the calcium level at 6 and 18 hours, sufficient to establish a calcium trend. All the patients who had registered a positive or doubt trend of calcium levels can be discharged the day after surgery, with minimum risk of subsequent hypocalcemia. The cases that registered a negative trend of calcium levels during the recovery, can not be considered as certain indicator of late hypocalcemia and therefore it is necessary to measure the PTH level, which gives highly predictive values both in scientific literature and also in our research: in 93,5% of the cases, a correlation between the PTH levels and an eventual development of hypocalcemia was noted.
Background: The purpose of this retrospective study was to evaluate factors influencing morbidity and mortality associated with right or transverse colectomy. Methodology: We included all patients receiving a right or transverse colectomy from January 1-st, 2002 until December 31-st, 2007 for a total of 111 patients. Seventy-nine patients (71.8%) were treated with open surgery and 31 (28.2%) with laparoscopic surgery. Seven patients (22.6%) required a conversion from laparoscopic to open surgery. Results: Morbidity and mortality were 32.7% and 2.7%, respectively. The age, rate of local complications, duration of hospitalization and stays in the intensive care unit, tumor size, proportion of positive ganglions, and the rate of neoplasic recurrence were all statistically more common in patients treated with open surgery compared to laparoscopic surgery. There was no difference between groups in terms of male / female ratio, BMI, general morbidity, short- and long-term mortality, number of examined ganglions, and local recurrence. Patients with stage 1 disease were more common in the laparoscopic group. Conclusion: The lower rate of local morbidity, shorter hospital stay, and equivalent survival and long-term outcome recommend laparoscopic colectomy in patients whose medical status and disease stage allow for the use of this minimally invasive procedure.
In the nineteenth century, Bassini pioneered inguinal hernia repair and to this day many hernias are still repaired with similar sutured methods. The recurrence rate of these is seriously high – up to 20% and long-term pain is common. Time and technology have moved on, but many surgeons have not. In the twenty first century, recurrence of less than 1% is attainable, with almost no significant pain. It is already over-time for change.
A patient with symptomatic gall stones was found to have a hernia of Morgagni. The patient complained of upper abdominal symptoms along with heaviness in the chest and mild dyspnea. A complete diagnosis was possible with a chest X ray and a CT scan, which revealed a right-sided Morgagni hernia containing omentum and some bowel loops. It was decided to laparoscopically deal with both lesions at the same sitting. Initially, a laparoscopic cholecystectomy was accomplished. The hernial contents were then reduced and an 8 cm x 5 cm defect was closed with a tailored mesh sutured in place with a hernia stapler. Follow up after one month showed an asymptomatic patient confirmed by CT scan. Morgagni hernia is eminently treatable laparoscopically and must be considered as a first line approach to this problem. It can safely be combined with other laparoscopic procedures.
Primary laparoscopic repair of Morgagni-Larrey hernia has been described in adult patients but not in children. This is the first report of primary laparoscopic correction in the pediatric age group without using a prosthesis. A Morgagni-Larrey hernia was found incidentally in a 3-year-old-girl. Laparoscopic correction of the defect was performed. After 6 months the patient is doing well. The chest radiograph shows complete resolution of the hernia. The laparoscopic approach allowed repair the hernia with minimal invasiveness. Laparoscopic correction is not difficult except for those hernias in which dense adhesions are present.
A patient undergoing laparoscopic Nissen fundoplication had an intraoperative finding of a left Bochdalek hernia, which was repaired with an onlay of fenestrated PTFE. This appears to be the first report of such a case.
Diaphragmatic hernias of the Bochdalek type are rare in adults. The diagnosis may be made with radiography of the chest in an asymptomatic person or in a person with respiratory and/or gastrointestinal symptoms. It has been mistaken for pleural effusion, empyema, lung cysts, and pneumothorax. A 38-year-old woman presented with epigastric pain and a persistent cough of 2 months' duration. A chest radiograph showed bowel loops in the left side of the chest. On laparoscopy, two defects, measuring 10 and 4 cm, respectively, were seen in the left hemidiaphragm. The herniated fundus of the stomach was reduced and the defect repaired with Gore-Tex mesh (W. L. Gore & Associates, Inc., Flagstaff, AZ, U.S.A.). The patient had an uneventful recovery. Laparoscopic repair of the rare Bochdalek hernia is feasible.
The Morgagni hernia is the rarest form of diaphragmatic hernias. Knowledge has been accumulated over time of combinations with other congenital malformations, familial occurrence, and traumatic genesis. Morgagni hernia has been more often recordable from women, along with rising age and usually located on the right hand side. Embryonic disorder of diaphragmatic differentiation is believed to be the major aetiological factor. Vitamin deficit as well as some chemical substances, primarily active in the foetal period, have become known as additional factors of predisposition. Intensive diagnosis to rule out malignancy is absolutely essential because of the variability of symptoms of this type of hernia. Colon fragments and large omentum were found to be most often contained in the hernial sac. Contrast medium X-ray checks of the gastrointestinal tract and pneumoperitoneum are preferential methods of examination. Exploratory laparotomy is generally considered the optional therapeutic approach because of possible saving of liver veins, safe removal of the hernial sac, and the possibility of abdominal exploration. Preoperative wide-range sterile covering of the patient's body around the site of surgery is recommended to allow for possible thoractomy, as may be required.
A case is presented of a patient with a congenital hernia of Morgagni that was diagnosed after a motorcycle accident. These may be confused with a traumatic diaphragmatic hernia. The lateral chest film is helpful in the differential diagnosis. The barium enema is usually diagnostic.
A hernia of Morgagni was successfully repaired laparoscopically by reducing the hernia, mobilizing the peritoneum around the perimeter of the defect, and stapling polypropylene mesh onto the surrounding fascia. This type of repair is technically easy and should give a high probability of success.
A new case report of laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni in a 53-year-old woman is described. The patient had a successful recovery with no recurrence 2 years after surgery. The authors propose that the laparoscopic approach is an alternative to classical treatment for this kind of hernia.
Foramen of Morgagni hernias have traditionally been repaired by either an abdominal or a transthoracic approach. We describe a case in which a Morgagni hernia that presented as a gradually enlarging right anterior pericardiophrenic mass was both diagnosed and repaired using video-assisted thoracic surgery. The procedure went without incident, and the patient had an uneventful postoperative course. The video-assisted thoracic surgical repair can be a safe and effective way to fix a Morgagni hernia.
The authors present a case of laparoscopic repair of a symptomatic Morgagni hernia in an adult patient. The indication for surgery was based on symptoms of dyspnea and sensation of thoracic tightness. A tension-free closure of the defect using a Marlex mesh was carried out. Recovery was quick and uneventful. One year after surgery, no complaints were noticed. Aetiology, diagnosis and treatment are discussed.
A 78-year-old woman is described who presented with a diaphragmatic hernia through the foramen of Morgagni. A definitive diagnosis was confirmed by a sagittal view on magnetic resonance imaging prior to surgery. The hernia was repaired laparoscopically under an abdominal wall lifting technique without pneumoperitoneum, and her symptoms completely resolved postoperatively with no evidence of recurrence. The laparoscopic repair was considered a suitable and safe procedure for the treatment of a Morgagni hernia.
Laparoscopic treatment of a Morgagni's di-aphragmatic hernia
- Rodriguez-Santiago Jm
- E Cugat
- C Hoyuela
- E Veloso
- Marco
Rodriguez-Santiago JM, Cugat E, Hoyuela C, Veloso E, Marco C: Laparoscopic treatment of a Morgagni's di-aphragmatic hernia. Surg Endose 1998;12:778.