Laparoscopic Morgagni Hernia Repair

Benjamin Biteman, MD, Fredrick Brody, MD, FACS. The George Washington University Medical Center

Introduction: Morgagni hernias are a defect in the anterior diaphragm within the sternocostal triangle. They are rare, comprising <5% of all diaphragmatic hernias. More than 50% of this type of diaphragmatic hernia are symptomatic. We present a small case series involving laparosopic repair of these diaphragmatic hernias with primary closure and underlay mesh. We present a video and radiographs of a 76yo male with a right diaphragmatic defect with multiple loops of small bowel protruding into the anterior aspect of the chest.

Methods: Typical 4 port foregut laparoscopic approach. Primary closure with intracorporeal suturing and underlay composite polypropylene mesh with transfascial tacks.

Results: In our small case series of 3, all videos show superior visualization with safe reduction of bowel contents from the thoracic cavity. All patients were discharged postoperative day 2 with no readmissions and no morbidities. Follow up imaging has shown no evidence of recurrence at 2 years.

Discussion: Laparoscopy provides optimal visualization and rapid recovery compared to traditional open abdominal or thoracic approaches. Laparoscopic approach with primary closure and mesh underlay is effective and durable.

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