Julie G Grossman, MD, Arghavan Salles, MD, PhD. Washington University School of Medicine
INTRODUCTION: Morgagni hernias are congenital defects found in the anterior space of the diaphragm. They are the rarest of the congenital diaphragmatic hernias, making up only 3% of all diaphragmatic hernias. It is an especially rare entity among adults and because of this, definitive management strategies have not been well-defined. We present an effective method of laparoscopic repair.
PROCEDURES: Two cases of laparoscopic Morgagni hernia repairs were performed on symptomatic adult patients, who had preoperative complaints of chest and abdominal pain.
RESULTS: Primary closure of Morgagni hernia defects were performed in two different ways, utilizing a trans-fascial mattress repair. The first was anterior-posterior, while the second was closed transversely. Polypropylene mesh was used to reinforce the repair. Tacks were utilized for mesh placement in all areas, except for the posterior edge, which was in proximity to the heart, where fibrin sealant was used. Both patients did well postoperatively and remain free of symptoms.
CONCLUSION: The laparoscopic approach allows for a short post-operative course, good long-term outcomes, and increased intraoperative visualization with minimal morbidity. We have shown that the use of trans-fascial sutures is technically feasible and allows for secure closure of the defect. Additionally, we have illustrated the use of fibrin sealant for mesh fixation in areas which are inappropriate for tacks, such as in proximity to the heart. In summary, Morgagni hernias are rare among adults but can be treated laparoscopically, while also allowing for primary closure of defects.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95535
Program Number: V209
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop