Thomas Ng, MD, Beth Ryder, MD, Shair Ahmed, MD. Brown University, Rhode Island Hospital
Foramen of Morgagni hernias are extremely rare. Most are asymptomatic and found incidentally, however may present with vague non-specific abdominal complaints. Upon diagnosis, operative intervention should be undertaken for the risk of incarceration and strangulation. Repair should include complete sac excision and anchoring of mesh circumferentially.
Laparoscopic repair was utilized, reducing the contents of the hernia using atraumatic bowel graspers, followed by excising the hernia sac allowing definition of the edges. Blunt dissection was used to remove the sac from the mediastinum. A 1mm Gortex patch was used to achieve a tension free repair. Intracorporeal suturing anchored the posterior edge of the mesh. Transfascial sutures were used to anchor the mesh anteriorly, in addition to using laparoscopic tacks to reinforce the repair.
The patient tolerated the procedure well, resuming a normal diet and discharged 24 hours postoperatively with resolution of symptoms on follow up.
The repair of a Foramen of Morgagni hernia can be accomplished laparoscopically. Great care must be used to reduce hernia contents. The hernia sac should be excised in order to identify defect edges precisely; careful blunt dissection should only be used to dissect the mediastinum in order to avoid injury to the phrenic nerve and avoid entering the pleura causing a pneumothorax. Repair of the defect by patch is optimal to avoid tension on the repair, the posterior edge is sutured to diaphragm; the anterior edge was secured with the use of transfascial sutures as there may be no anterior edge to suture intracorporally.
Program Number: V064