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Laparoscopic repair of a newly diagnosed Morgagni hernia in a patient with prior paraesophageal hernia repair

Julietta H Chang, MD, Ozanan Meireles, MD, David W Rattner, MD. Massachusetts General Hospital

Anterior diaphragmatic hernias were first described by Morgagni in 1769. Unlike Bochdalek hernias, these tend to be smaller and clinically less significant on pulmonary function in the neonatal period. However, they can become symptomatic as they enlarge in adulthood. 

Our patient is a 49-year-old female who presented with a new anterior diaphragmatic hernia. She had a history of gastroesophageal reflux disease treated with a laparoscopic Nissen fundoplication in 2002 complicated by a slipped Nissen, for which she underwent a laparoscopic redo fundoplication as well as primary closure of her hiatal hernia 2 years later. At the time, her anterior diaphragm was noted to be intact. She presented over a decade later to her primary care physician with productive cough. A chest CT was ordered to further characterize her presumed pneumonia when a large anterior diaphragmatic hernia containing fat and colon was noted as well as an intact Nissen wrap. She was taken to the OR where she underwent successful laparoscopic primary repair of her diaphragmatic hernia. 

Principles of repair are reduction of hernia contents with durable closure of the defect. Hernia sac excision, as routinely done in paraesophageal hernia repair, has been largely abandoned due to longer operative time, as well as increased risk of injury to the pleura and superior epigastric vessels.

In conclusion, we present a 49 year old female who presented with a newly developed Morgagni hernia. They can be acquired later in life due to increased intraabdominal pressure or laxity involving the diaphragm, such as in our patient. Laparoscopic repair is feasible and durable with the added benefits associated with laparoscopic approach, including decreased postoperative pain, wound morbidity, and decreased length of hospital stay.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88094

Program Number: V197

Presentation Session: Wednesday Video Loop (Non CME)

Presentation Type: VideoLoop

36

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