Kristin Stevens, MD, Gordon Wisbach, MD, Karen Hanna, MD, Brian Barbick, MD MPH. Naval Medical Center San Diego
Laparoscopic Repair of Incarcerated Bilateral Morgagni Hernia
Introduction: We present a case of a completely laparoscopic repair of a large chronically incarcerated bilateral morgagni hernia containing small bowel.
Methods: Our patient is a seventy six year old female who was found incidentally to have a chronically incarcerated bilateral morgagni hernia containing a large amount of small intestine on a cardiac gated CT done for surveillance of her thoracic aortic aneurysm. She was referred to general surgery where she endorsed a one-year history of shortness of breath and dyspnea on exertion. She denied any abdominal symptoms. She was sent for pulmonary function tests, which showed mild restrictive lung disease. After clearance by cardiology the patient was consented for a laparoscopic, possible open repair of the morgagni hernia.
Results: The patient underwent an uncomplicated, totally laparoscopic repair of the morgagni hernia. This was completed as a primary repair with mesh overlay. The defect measured seven by four centimeters. The case lasted three hours and five minutes and there was fifty milliliters of blood loss. The patient was transferred to the ICU for overnight observation and she was started on clears immediately after surgery. On POD 1 she was transferred to the floor and started on a regular diet. She was discharged home on POD 2 in good condition. She was seen in follow up at two weeks and again at two months and was doing well. On follow up she stated that her shortness of breath and dyspnea on exertion had resolved. She had returned to her usual activities and resumed her normal exercise routine.
Conclusions: While morgagni hernias are uncommon, they are often found in elderly individuals who have multiple comorbidities. Due to the risk of incarceration and strangulation it is generally recommended that they be repaired. We show that large chronically incarcerated morgagni hernias may be safely repaired laparoscopically by surgeons with advanced laparoscopic training.
Session Number: VidTV2 – Video Channel Rotation Day 2
Program Number: V120