Laparoscopic Repair of Morgagni Hernia in Children

PurposeThis study aimed to evaluate our patients who underwent laparoscopic-assisted transabdominal repair for Morgagni hernia (MH).MethodsWe retrospectively reviewed patients who underwent laparoscopy-assisted transabdominal repair using loop sutures for MH between March 2010 and April 2021. Demographic data, symptoms, operative findings, operation methods, and postoperative complications of the patients were reviewed.ResultsA total of 22 patients with MH were treated with laparoscopy-assisted transabdominal repair using loop suture. There were 6 girls (27.2%) and 16 boys (72.7%). Two patients had Down syndrome, and two patients had cardiac defects (secundum atrial septal defect, patent foramen ovale). One patient had a V–P shunt due to hydrocephalus. One patient had cerebral palsy. The mean operation time was 45 min (30–86 min). The hernia sac was not removed, and a patch was not used in any of the patients. The mean hospitalization time was 1.7 days (1–5 days). One patient's defect was very large, and another patient's liver was densely attached to the liver sac, causing bleeding during dissection. In total, two patients were converted to open surgery. There was no recurrence during the follow-up.ConclusionLaparoscopy-assisted transabdominal repair is an efficient and safe choice for the repair of MH. Leaving the hernia sac does not increase the recurrence, so there is no need to dissect the sac.     

Laparoscopic Features and Repair of a Combined left Spigelian Hernia and left Morgagni Diaphragmatic Hernia

Both Spigelian and Morgagni hernias cause serious morbidity so early diagnosis and timely treatment are necessary. These two types of hernia are more commonly found on the right side of patients. They are rare individually in adults and even rarer in combination. So far, an association between the two hernias has only been reported on the right. We describe the first case of a Spigelian hernia and a Morgagni hernia in a 62-year-old woman, both occurring on the left side. Our accompanying video describes several laparoscopic features that will help lead to early detection and diagnosis.     

Laparoscopic Repair of Paraesophageal Hernias

Background and Objectives:

Laparoscopy has quickly become the standard surgical approach to repair paraesophageal hernias. Although many centers routinely perform this procedure, relatively high recurrence rates have led many surgeons to question this approach. We sought to evaluate outcomes in our cohort of patients with an emphasis on recurrence rates and symptom improvement and their correlation with true radiologic recurrence seen on contrast imaging.

Methods:

We retrospectively identified 126 consecutive patients who underwent laparoscopic repair of a large paraesophageal hernia between 2000 and 2010. Clinical outcomes were reviewed, and data were collected regarding operative details, perioperative and postoperative complications, symptoms, and follow-up imaging. Radiologic evidence of any size hiatal hernia was considered to indicate a recurrence.

Results:

There were 95 female and 31 male patients with a mean age (± standard deviation) of 71 ± 14 years. Laparoscopic repair was completed successfully in 120 of 126 patients, with 6 operations converted to open procedures. Crural reinforcement with mesh was performed in 79% of patients, and 11% underwent a Collis gastroplasty. Fundoplications were performed in 90% of patients: Nissen (112), Dor (1), and Toupet (1). Radiographic surveillance, obtained at a mean time interval of 23 months postoperatively, was available in 89 of 126 patients (71%). Radiographic evidence of a recurrence was present in 19 patients (21%). Reoperation was necessary in 6 patients (5%): 5 for symptomatic recurrence (4%) and 1 for dysphagia (1%). The median length of stay was 4 days.

Conclusion:

Laparoscopic paraesophageal hernia repair results in an excellent outcome with a short length of stay when performed at an experienced center. Radiologic recurrence is observed relatively frequently with routine surveillance; however, many of these recurrences are small, and few patients require correction of the recurrence. Furthermore, these small recurrent hernias are often asymptomatic and do not seem to be associated with the same risk of severe complications developing as the initial paraesophageal hernia.     

Laparoscopic repair of Morgagni hernia

Background Foramen of Morgagni hernias are rare diaphragmatic hernias. They account for 3–5% of all diaphragmatic hernias and the majority of the cases are asymptomatic. They are caused by trauma, obesity or pregnancy. With the advancements of laparoscopic surgery, laparoscopic repair has become an excellent alternative to open repair for Morgagni hernias. We report five cases of Morgagni hernia repaired with the laparoscopic approach in conjunction with a review of the literature. Patients A retrospective review comprised five patients who had a Morgagni hernia repaired with a laparoscopic approach. Data from these patients were collected for the period between February 2001 and May 2005. Results The average age at operation was 61. The anatomic pathology was detected preoperatively using X-rays and computerized tomography (CT) scans in four of our patients. Hernia was detected incidentally in one patient during an elective cholecysectomy. Three hernias were right-sided and two were left-sided. The contents of the hernias were omentum and transverse colon in the majority of the patients. The hernia was repaired with a laparoscopic approach in all patients. Four patients had composite mesh repair and one patient had primary closure with nonabsorbable sutures. There were no postoperative complications and all patients tolerated laparoscopic repair. There were also no recurrences during follow-up. Conclusions Laparoscopic repair is a candidate to be a standard treatment for Morgagni-type hernias. It is an effective and safe technique and can be performed by all compotent general surgeons with a certain learning curve. It has several advantages relative to the open operation.     

Laparoscopic repair of a Morgagni hernia

Laparoscopic repair of a diaphragmatic hernia through the right sternocostal foramen of Morgagni in an obese 42-year-old man is described. The indications for surgery were symptoms of strain-induced dyspnea and tightness in the chest. The technique was carried out by incorporating a marlex mesh into the defect and fixing it in place with hernia staples. The patient had an immediate recovery after repair of the hernia and has remained free of recurrence or complaints 9 months after surgery.     

Laparoscopic repair of Morgagni diaphragmatic hernia

Background: Morgagni diaphragmatic hernia is a rare congenital hernia that lies retrosternal through a congenital defect between the sternal and costal portions of the diaphragm. Surgical repair of Morgagni hernia is recommended because incarceration or strangulation of bowel within the thoracic cavity may occur. Methods: A case of Morgagni diaphragmatic hernia is presented and laparoscopic repair using Gore‐Tex DualMesh is described. Results: There was complete resolution of the patient’s symptoms including her dyspnoea. There were no postoperative complications. Conclusion: Laparoscopic repair of Morgagni diaphragmatic hernia is a safe and effective method for treating this rare surgical condition. The use of dual‐layer mesh allows tension‐free repair without the risk of intra‐abdominal adhesions forming between bowel and mesh.     

Laparoscopic Intraperitoneal Repair of Incisional and Ventral Hernias

Background : After reports in the literature on the safety and feasibility of laparoscopic repair of ventral hernia, and with the potential advantages of the minimal invasive approach, we started to perform this technique in 2001. This study was done to evaluate the results of our initial experience.

Methods : From March 2001 to October 2003, all patients with a ventral hernia greater than 4 cm were planned to have a laparoscopic repair. Patients were studied retrospectively, collecting data on preoperative and intraoperative variables, complications and recurrences.

Results : In 49 patients, out of 52 patients planned, laparoscopic repair was performed. The indication was incisional hernia in 88% and recurrence after open hernia repair in 43%. The mean hernia surface area was 86,6 cm² and 43% had a width greater than 10 cm. There were no intraoperative complications and the mean operating time was 103 min. Postoperative complications were seen in 9 patients (18,4%). Mean hospital stay was 5,9 days. Mean follow-up was 14,3 months. Late complications were seen in three patients (6,1%). Recurrence was present in one patient (2,0%). Conclusions : Laparoscopic repair of incisional and ventral hernia is a safe alternative for open mesh repair. Further definition of indications is needed, based on the dimension and the localization of the hernia. If the omission of transabdominal wall sutures improves the postoperative course with no adverse effect on recurrence rate, will be the subject of a randomized trial we have started this year.     

Case report: Morgagni hernia

The case reported here is a 32-year-old man with a sudden onset of chest pain and an acute deterioration of lung function. An incarcerated Morgagni hernia was diagnosed with a computer tomographic CT scan, and repaired electively via a midline laparotomy. Morgagni hernia is a rare type of congenital diaphragmatic hernia, which may not be symptomatic until adulthood when the patient presents with acute symptoms or incarceration.     

Results of Performing Mesh Plug Repair for Groin Hernias

The simplicity and good postoperative results of mesh plug repair for groin hernias have been reported in numerous articles. We have been performing this procedure in our department for more than 5 years, and the present study was conducted to reexamine its clinical outcome from our viewpoint. A total of 224 patients with a collective 244 groin hernias underwent mesh plug repair between March 1993 and August 1998. There were 155 (63.5%) indirect hernias, 79 (32.4%) direct hernias, 2 (0.8%) femoral hernias, and 8 (3.3%) compound hernias; 27 (11.1%) were recurrent hernias. Two plugs were inserted in all the compound hernias and in two of the direct hernias with a diffuse weak inguinal floor. The mean operating time was 32.2 min. The complications that developed during this study were continuous pain in four patients, seroma in two, and hematoma in one. The rates of recurrence were 0% for indirect hernias and 12.7% for direct hernias. The patients in whom recurrence developed underwent mesh plug repair again and have had no further recurrence. Our experience showed mesh plug repair to be an excellent technique for indirect hernias or recurrent hernias after mesh repair, but it might be unsuitable for direct hernias with a diffuse bulging weakness in the floor of the inguinal canal. Received: November 25, 1999 / Accepted: September 26, 2000     

Prevalence of Internal Hernias After Laparoscopic Colonic Surgery

Introduction  Laparoscopic approach for colorectal resections is gaining popularity. Internal small bowel herniation (SBH) through a mesenteric defect has been described and, although rare, is a severe complication. The aim of this study was to evaluate the incidence and outcome of internal hernias after laparoscopic colorectal resection. Material and methods  During a 5-year period, all patients who underwent laparoscopic left colon resection were included in the study. A retrospective data base query was performed searching for all patients in whom SBH required surgical reintervention. Results  A total of 436 laparoscopic left colorectal resections were performed from January 2000 to July 2006. Five male patients presented symptomatic internal hernias and required re-operation. Four had a resection for cancer and one for sigmoiditis. The mesenteric defect was not initially closed in three cases. In all cases, we found small bowel hernias through the mesocolon defect. One patient was re-operated on post-op day 2 for mesenteric ischemia and died after 24 h. Discussion  Internal hernia is a rare but fatal complication after laparoscopic colonic resection. Suspicion of this diagnosis requires emergency re-operation because symptoms are nonspecific. Conclusion  All mesenteric defects created during colorectal laparoscopy surgery should be meticulously closed. SAGES April 2007, Las Vegas     

Transthoracic Repair of Asymptomatic Morgagni Hernia in an Adult

Morgagni hernia represents a rare type of diaphragmatic hernia which usually occurs on the right side, in the anterior mediastinum. Predisposing factors of Morgagni hernia include pregnancy, obesity or other causes of increased intraabdominal pressure, and a history of trauma. Most of adults diagnosed with a foramen of Morgagni are asymptomatic. We report a case of an overweight 23-year-old asymptomatic patient with a Morgagni hernia incidentally diagnosed on chest x-ray. There was a satisfactory result after the repair by a transthoracic approach.     

Hernia of foramen of Morgagni in adult: case report of laparoscopic repair.

The videolaparoscopic repair of a diaphragmatic hernia of Morgagni by external knot tying technique is described. A 69-year-old woman with subocclusive symptoms by intrathoracic migration of abdominal viscera had an immediate and complete postoperative recovery. The hernial sac was not excised. A four-year follow-up shows no hernia recurrence. This case indicated that the laparoscopic approach can be considered a suitable and safe procedure for treatment of Morgagni's hernia.     

Laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni

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. Received: 3 April 1996/Accepted: 3 May 1996     

Morgagni hernia: Repair with a mesh using laparoscopic surgery

The aim of this study is to present two patients diagnosed with diaphragmatic Morgagni hernia and treated by repairing the hernia defect with a mesh by laparoscopic surgery. We describe the placement of a double-layer mesh anchored with helicoidal staples to repair the hernia defect using laparoscopic surgery. Laparoscopic surgery allows repair of these defects whilst avoiding the disadvantages of a major laparotomy or a thoracotomy. The existence of double-layer meshes that can be placed in contact with the abdominal viscera allows the defect to be closed safely and without tension.     

Laparoscopic repair of diaphragmatic Morgagni hernia in children: review of 3 cases

This article retrospectively reviews the laparoscopic repair of Morgagni hernias in 3 children. The surgical procedure was performed by closing the defect using extracorporeal, interrupted, nonabsorbable sutures. Recovery was uneventful in all 3 patients. There were no recurrences and the chest radiograph stayed normal during the postoperative follow-up.     

Robotic repair of Morgagni congenital diaphragmatic hernia in an infant

We describe a robotic repair of a large Morgagni congenital diaphragmatic hernia in a 12-month-old infant using the da Vinci surgical robot.     

腹腔镜下切口疝修补术并发症的处理

目的探讨腹腔镜下切口疝补片修补术后并发症发生的原因及处理方法。方法回顾性分析2004年3月～2007年5月采用腹腔镜补片修补术治疗的110例切口疝的临床资料。男42例，女68例，年龄33～89岁（平均65岁）。结果1例因腹腔内广泛粘连而中转开放修补，余109例手术成功。术后并发症：术后腹胀15例（13．6％），修补区腹壁疼痛86例（78．2％）（其中2例持续时间≥6周），血清肿23例（20．9％），尿潴留6例（5．4％），急性胃扩张2例（1．8％），肠管损伤2例（1．8％），呼吸功能障碍2例（1．8％），复发2例（1．8％）。结论术前准备不足，腹腔内的粘连，视野暴露困难，盲目电凝操作，补片偏小及固定不恰当等是导致手术并发症的关键。     

Transabdominal Approach in the Surgical Management of Morgagni Hernia

Purpose Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far only limited data have been reported. The objective of this retrospective study was to evaluate the outcome of patients presenting with a complicated Morgagni hernia and who undergo a transabdominal repair. Methods Between September 1999 and October 2005, 11 patients with Morgagni hernia were operated on in our department. Eight of them had acute presentations because of a complicated Morgagni hernia. The patient demographics, presenting symptoms, operative approach, and complications were collected. The postoperative course was evaluated for morbidity and mortality. Results The patients' ages ranged from 42 to 85 years (mean 69.4). Two (18.2%) patients were male and nine (81.8%) patients were female. Chest roentgenograms, computed tomography, and contrast meal studies were used as diagnostic utilities. A transabdominal approach was used for all patients. One patient died due to pulmonary failure. The mean follow-up was 2.8 years. There was no recurrence or symptoms regarding the operation in the remaining patients. Conclusion We recommend the transabdominal approach in patients with Morgagni hernia as it makes it easy to reduce the hernia contents and repair of the hernia sac. Moreover, when complicated with strangulation, incarceration or perforation, a surgical repair through a transabdominal approach is mandatory.     

Presentation and management of Morgagni hernias in adults: a review of 298 cases

Background  Morgagni hernias are a very rare form of diaphragmatic hernias. No robust studies have been performed to show the true natural history of this disease process. This study aimed to summarize clinically relevant data with respect to Morgagni hernias in adults. These data should help surgeons workup, diagnose, and treat Morgagni hernias in adult patients. Methods  A literature search was performed using PubMed, Google scholar, and the following key words: Morgagni, Larrey, retrosternal, retrocostoxiphal, retrochondrosternal, parasternal, substernal, anterior diaphragmatic, and subcostosternal. All case reports and series after 1951 that pertained to adults were included in the review. The following data points were queried: age, sex, presentation, studies used during workup, laterality, surgical approach, hernia sac management, specific laparoscopic techniques, and follow-up evaluation. Results  These criteria were met by 135 articles representing 298 patients. Based on the data provided, several conclusions regarding this disease process can be drawn. Most patients (72%) present with symptoms related to their hernia. Pulmonary complaints are the most common symptoms (36%). Men present earlier in life than women. Thoracotomy is the most widely used surgical approach (49%). However, laparoscopic repair has gained popularity since its first report in 1992. Laparoscopic surgeons usually repair the defect with mesh (64%) and do not remove the hernia sac (69%). Laparoscopic repair can be performed with a low complication rate (5%) and a short hospital stay (3 days). Outcomes of other surgical approaches also are reported. Conclusions  Using modern surgical techniques including laparoscopy, repair of Morgagni hernia can be performed safely with a short hospital stay and with little morbidity or mortality. The views expressed in this document are those of the author(s) and do not reflect the official policy of the William Beaumont Army Medical Center, the Department of the Army, the Department of Defense, or the United States Government.