Stephen Sharp, MD, Tejinder P. Singh, MD. Albany Medical Center
Objectives: Morgagni hernias are classified as congenital diaphragmatic hernias and are relatively uncommon. They are caused by a failure of fusion between the septum transversum and the lateral body wall where the internal mammary artery crosses the diaphragm. Traditionally they have been fixed in an open fashion either transthoracic or transabdominal. Relatively recently they have been fixed laparoscopically with mesh using a tacking device. In this video, we demonstrate a pre-peritoneal anatomical reconstruction where the diaphragm is sutured to the anterior abdominal wall, the repair is buttressed with mesh, and the peritoneum is closed over the mesh.
Methods: A 58-year old male with upper abdominal pain found to have Morgagni hernia. The patient was taken to the operating room and placed under general anesthesia. A 12-mm umbilical balloon-tipped trocar and two 8-mm robotic trocars in the right and left mid-abdomen were placed. The Morgagni hernia was identified. Colon and omentum were easily reduced from the hernia defect. A peritoneal flap in the upper abdomen was created and carried cephalad towards the diaphragm and chest. Diaphragm muscle was dissected and found to be easily approximated to anterior abdominal wall in a tension-free manner. The hernia defect from the diaphragm to the anterior abdominal wall was then closed with #1 Stratafix in a running fashion. A 15cm x 15cm ProGrip mesh was then placed in an extra-peritoneal manner to cover the hernia defect as well as adjacent diaphragm and abdominal wall. The peritoneum was then re-approximated and closed in a tension-free manner using 2-0 Stratafix in a continuous manner. Umbilical trocar site closed with 0-Vicryl in a figure-of-eight fashion. Skin closed with 4-0 Monocryl and Dermabond glue.
Results: The patient was discharged home on POD #1 and had no complications.
Conclusion: Robotic repair is a durable option for an anatomical repair of Morgagni hernias.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87668
Program Number: V114
Presentation Session: Robotics 2 Session
Presentation Type: Video