C Hassan, LF Gonzalez Ciccarelli, A Gangemi, M Masrur, F Bianco, P Quadri, L Sanchez-Johnsen, P Giulianotti. University of Illinois at Chicago
Introduction: Morgagni hernia is congenital diaphragmatic defect presenting most commonly in children and extremely rare in adults. This hernia is most often asymptomatic and diagnosed incidentally. When symptomatic this hernia is associated with abdominal pain, discomfort, loss of appetite and chronic respiratory symptoms.
Methods and Results: We present a case of a 31-year-old female with a BMI of 53.2 kg/m2 and a past history of obstructive sleep apnea with no past surgery presented to clinic seeking bariatric surgery after reporting a lifelong history of obesity. Patient underwent fluoroscopy that showed normal esophagogram with a negative hiatal hernia and an enlarged cardio-mediastinal silhouette. The patient was elected to undergo laparoscopic sleeve gastrectomy. Diagnostic laparoscopy was performed and an incidental finding of a Morgagni hernia was diagnosed. A significant section of the transverse colon was incarcerated in the diaphragmatic defect. The content was carefully reduced laparoscopically. Hernia content was directly in contact with the pericardium. The pericardium was visualized at the midline and the distal stomach and pylorus were identified. The hernia measured approximately 8 cm. Primary repair of the hernia was performed with interrupted non-absorbable 0 sutures. Mobilization and dissection of the greater curvature was then performed using a stapler in order to create the gastric sleeve, 8 cm proximal to the pylorus and 1 cm to the left angle of His. A 40 French Bougie was used to size the lumen. Intraoperative air leak test was negative. Overall operative time was 162 minutes with an estimated blood loss of approximately 50 ml. Postoperative course was uncomplicated. Patient was discharged tolerating liquid diet on postoperative day three. At 3-month follow up, patient was doing well, tolerating full diet with no dyspnea or signs of recurrence and an excess weight loss of 27%.
Conclusion: Simultaneous Laparoscopic Sleeve Gastrectomy and Morgagni hernia repair is safe and feasible surgery in experienced hands.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95765
Program Number: V184
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop