Indraneil Mukherjee, MD, Aleksandr Demin, DO, Andrey Mironenko, MD, Karen E Gibbs, MD, Aleksandra Ogrodnik, MD. Staten Island University Hospital
Introduction: Morgagni hernias are a rare congenital defect found in the anterior diaphragm between the costal margin and the sternum. The failure of fusion of the septum transverses during the 4th week of embryologic development produces the congenital tract just posterior to the sternum in the muscle free space of Larrey. Although rare these defects can be seen bilaterally. In the pediatric population the reported incidence is anywhere from 1-3%. Although most of these are asymptomatic, in this modern age they are more often diagnosed and repaired early making adult Morgagni hernias an uncommon entity. However, when symptomatic patients usually present with vague gastrointestinal and respiratory complaints. Progression of symptoms and complications include intestinal obstruction, perforation and ischemic bowel. Radiologic evaluation of these hernias is best performed with a Computerized tomographic scan to assess the size and content of hernia to plan for the surgical approach. Both Transthoracic and Transabdominal approaches have been used. Today Laparoscopic approach for the repair of the defect is more minimally invasive than Thoracoscopic approach.
Case Presentation: We present an 85 year old female with recurrent hospital admissions for gastric outlet obstruction treated with nasogastric tube decompressions. She was found to have a giant Morgagni hernia and was deemed too high risk for surgical repair. After we were consulted and having an informed consent she was taken to for a laparoscopic repair of the defect with mesh reinforcement. Intra-operatively the stomach and colon reduced spontaneously on insufflation. The small bowel and omentum was reduced. The adhesions between the omentum and hernia lip was lysed. The defect was found to be 10cm in diameter. The hernia was repaired primarily by using trans fascial interrupted sutures to approximate the diaphragm to the anterior abdominal wall. This repair was reinforce with a coated light weight polypropylene. She was discharge next day. She has been asymptomatic since then.
Discussion: Morgagni’s hernia, a rare congenital anterior diaphragm defect is usually repaired early in life. In adults Morgagni’s hernias is an uncommon entity, usually detected radiologically when done for some other symptoms. Both Transthoracic and Transabdominal approaches have been used. Our video and review of literature does show Laparoscopic approach for the repair of such defect is feasible and even in extremely large hernias and safe in the geriatric population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93769
Program Number: V365
Presentation Session: Video Loop Day 4
Presentation Type: VideoLoop