Matthew Benenati, DO, Alia Abdulla, DO, Linda Szczurek, DO, Adeshola Fakulujo, MD
University of Medicine and Dentistry of New Jersey
A 44year old female with several years of atypical chest pain associated with nausea and vomiting was found to have a right-sided anterior diaphragmatic, or Morgagni, hernia containing omentum. Prior cardiologic and gastroenterologic workups did not explain her pain until a CAT scan revealed the above finding. Therefore the patient underwent a laparoscopic repair of the hernia defect with partial primary closure and placement of synthetic mesh. There were no complications and the patient was discharged on postoperative day number four.
This paper outlines the techniques of the procedure in addition to summarizing available literature regarding types of mesh utilized in the adult population. Feasibility and safety of performing laparoscopic diaphragmatic hernia repairs has already been established. Current debates address which type of repair and/or mesh is most efficacious in this setting, as has been the trend for hernias elsewhere in the body. Recent literature show that mesh is typically used (Table 1)), most commonly a composite mesh, even if complete or partial primary repair is achieved. Interestingly, a survey from 2010 of over 2,5000 SAGES members showed that when a mesh is used during hiatal hernia repair, absorbable mesh is preferred. Limited evaluation of primary repair in conjunction with biologic mesh yielded acceptable results, though this does not seem to be current common practice. Thus, excluding hiatal hernia repairs and diaphragmatic hernia repairs in children, synthetic mesh appears to be most commonly used in adults whether for congenital or acquired defects.
Ideally, a prospective study that randomized types of mesh and included a long term followup to evaluate for complications and recurrence would be of great benefit to this debate. Accurate data may be difficult to obtain given the rare nature of this diagnosis. Until then, our treatment will be based on extrapolation of current literature and modern practices.
Session: Poster Presentation
Program Number: P275