Marco Di Corpo, MD, Ann Chung, MD, Carlos Fajardo, MD, Timothy Farrell, MD. University of North Carolina
This is a case report of a 53-year-old female who presented to our clinic with a many year history of shortness of breath. Over the past 3 months, the shortness of breath had progressed to the point where she required supplemental oxygen at night. Her only other symptoms are occasional heartburn and regurgitation; she denies all other symptoms.
CT scan: demonstrate a large midline anterior diaphragm hernia, presumably a Morgagni hernia, with the majority of her intraabdominal viscera herniated into her thoracic cavity and compressing her left lung.
Surgery: Laparoscopic Morgagni Hernia Repair
Trocars were placed in a similar position to that of a 5-port technique for antireflux procedures. A large midline anterior defect in the diaphragm was immediately identified. Due to the hernia, the contents of the intraabdominal cavity were displaced, finding the appendix lying in the left upper quadrant close to the spleen.
We began by reducing the contents of the hernia back into the abdominal cavity (small bowel, colon and greater omentum). Adhesions were divided to complete reduction. The left lung was clearly visible and we ensured that there would be no issues with lung entrapment from the chronic hernia by having anesthesia fully inflate the lung. The defect measured 6 cm wide and 7 cm in height. We performed a two layer primary repair of the hernia. First, we closed the defect in an interrupted fashion with nonabsorbable suture with pledgets using a combination of intracorporeal suturing and a suture needle passer. We then performed a second layer with a running noabsorbable barbed suture. This left a 6cm suture line.
We then inserted a 6 X 15cm composite mesh to cover the suture line. The mesh was secured using a combination of nonabsorbable suture and absorbable. Finally, we administered fibrin-glue over the mesh to help boster the mesh in place. The mesh was well-fixated and centered over the primary defect.
The patient tolerated the procedure well. She was started on a diet immediately postoperatively. By the time of discharge on post operative day 2, she was completely on room air and not requiring any supplemental oxygen and noting an improvement in her pulmonary symptoms.
She was seen in follow-up at 1 month and was not having any symptoms. She was continuing to do well at 3 month follow up.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94014
Program Number: V326
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop