Derek Tessman, DO, Saad Shebrain, MD. Western Michigan University School of Medicine
OBJECTIVE: The following video demonstrates a case presentation of incarcerated Morgagni hernia with successful laparoscopic transabdominal mesh repair.
METHODS: A 34-year-old morbidly obese female with 18-months history of intermittent, sharp epigastric and chest pain, associated with episodes of SOB. The pain increases after eating and before Bowel movement, but partially relived by bowel movement. Physical exam findings were unremarkable except for morbidly obesity and the presence of mild tenderness in the epigastric area. Laboratory tests were unremarkable. A CT scan of the abdomen showed incarcerated Morgagni hernia containing omentum and transverse colon. Surgery was indicated.
PROCEDURE: The patient was taken to the Operating Room for laparoscopic repair. Three ports were utilized with the 12 mm trocar placed in left upper quadrant, two 5 mm trocars in the supraumbilical and RUQ area. There were significant adhesions between the omentum/transverse mesocolon and hernia sac/defect. With gentle manipulation, the herniated omentum was carefully reduced. This was sharply and bluntly dissected. Transverse colon was reduced.
The adhesions between the hernia sac and defect were taken down. The hernia defect was cleared off adhesions and the falciform ligament was taken down. Given the chronicity and location of hernia, and weighing the risk/benefits, the decision was made not to excise the sac. The posterior edge of the hernia (retrosternal part of diaphragm) and anterior abdominal wall were approximated, and the defect was found to be amenable to primary repair with minimal tension. Using Endo Close™ Trocar Site Closure Device, and Endo Stitch Suturing Device, a multiple trans fascial-to-hernia defect sutures were taken in a U-shaped manner, the defect was closed. A 10 x 15 cm Ventralight (polypropylene) mesh was then utilized to enforce the primary repair. An 0-Ethibond trans fascial U-shaped suture was passed through the center of the mesh and used as a fixation point. The perimeter of the mesh was attached to the abdominal wall and diaphragm using ProTack™ 5 mm Fixation Device Attention was made to avoid injury of the pericardial area. The reduced hernia contents were examined prior to removing the trocars and deflating the CO2 pneumoperitoneum.
RESULT: The patient did well after surgery. She was discharged home on POD2. A 1-year follow up: the patient is doing well both clinically and radiographically (CXR).
CONCLUSION: Laparoscopic repair of incarcerated Morgagni hernia with mesh is feasible, safe and effective, and can be performed in obese patients with good outcome.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95577
Program Number: V250
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop