Rebekah Macfie, MD1, Sean Orenstein, MD1, David Tse, MD2. 1Oregon Health & Science University, 2Kaiser Permanente- Sunnyside Medical Center
Introduction: Morgagni hernias are a rare finding in the adult population, and represent 1-3% of all congenital diaphragmatic hernias. Multiple approaches to these rare hernias have been described in the literature. Here we present a novel technique of laparoscopic trans-abdominal repair using a combination of the Endo-Close device (Medtronic, Minneapolis, MN) and the TI-KNOT (LSI Solutions, Victor, NY.)
Methods: In a patient with a large left anterior diaphragmatic defect we performed trans-abdominal suturing utilizing the Endo-Close to perform primary closure of the defect, using the TI-KNOT to secure the pledged sutures along the anterior fascia. Due to the size of the defect (7 x 10 cm) this primary repair was buttressed with polyester mesh.
In a second patient with a smaller (6×8 cm) classic right-sided anterior diaphragmatic defect we similarly performed laparoscopic trans-abdominal suturing using the Endo-Close to traverse both the anterior and posterior fascia and the TI-KNOT to secure the sutures in order to perform a primary repair of the hernia. Both patients presented had an uneventful postoperative course and no indication of recurrence at 4 months.
Conclusions: Morgagni hernias present unique technical challenges. In our experience the combined use of trans-abdominal suture with laparoscopic knot replacement device allowed for completion of both cases laparoscopically with minimal tension on the repairs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84890
Program Number: P710
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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