Jeremy M Linson, MD, Ziad Awad, MD, FACS, FRCS, Ruchir Puri, MD, FACS. University of Florida College of Medicine Jacksonville
Background: Hernia of Morgagni was first described by Morgagni in 1769. A congenital diaphragmatic hernia located in antero-lateral position, it is rare, comprising about 2% of congenital diaphragmatic hernias, and it is predominantly right-sided. We present a case of a 58 year old obese female with complaints of nausea, vomiting, reflux, weight loss and shortness of breath exacerbated by eating. She had a history of smoking and COPD. The hernia was diagnosed on computerized tomography.
Methods: Upon entering the abdomen laparoscopically, we identified most of the transverse colon in the hernia along with the stomach and omentum. The contents were reduced into the abdominal compartment and the hernia sac was carefully teased away from the parietal pleura. Attachments to the sac were taken down with ultrasonic shears, and once completely freed, the sac was excised and removed. The hernia was noted to be bilobular, with a large lateral defect and a smaller medial defect that contained fat. The anterior and posterior aspects of the defect were then approximated at the lateral and medial edges to reduce the overall size of the defect while maintaining a tension-free repair. Final measurement of the hernia showed an 11x7x15cm defect. The peritoneal flap was then dissected off of the diaphragm before placing the mesh into the preperitoneal space and securing it with anchoring sutures in anterior, posterior, lateral and medial positions. The peritoneum was then reapproximated over the mesh using a running suture, thereby exluding it from the peritoneal cavity.
Results: The patient underwent a protracted post-operative course due to respiratory complications and was discharged home 3 weeks post-operatively. At 1 year follow-up she had no recurrence and improved respiratory and GI function.
Conclusions: Preperitoneal meshplasty of Morgagni hernias can be accomplished safely and effectively using a laparoscopic approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87959
Program Number: V152
Presentation Session: Hernia Videos Session
Presentation Type: Video