Angela M Kao, MD, Michael R Arnold, MD, Julia E Marx, Paul D Colavita, MD, B Todd Heniford. Carolinas Medical Center
Introduction: Morgagni hernia is an anteromedial congenital diaphragmatic hernia seen in approximately 1 in 3000 live births and rarely identified in adulthood. Patients may be asymptomatic, have intermittent symptoms, or present acutely with incarceration/obstruction. Given this, surgical repair is recommended, but a standardized technique has not yet been described.
Methods: A prospectively collected hernia-specific database was queried for all adult Morgagni hernias performed at a tertiary hernia center. Demographics and peri-operative data were compared.
Results: From 1/2007 to 8/2017, 15 patients (86.7% female, median age 63 ± 13.8 years, mean BMI 33.1 kg/m2 , range 16.3-46 kg/m2) were diagnosed with a Morgagni hernia. 86.7% of patients had previous abdominal surgery. The most common presenting symptoms were abdominal pain (66.7%), reflux (40.0%), obstruction (33.3%), or asymptomatic (20%). Two patients (13.3%) presented emergently with acute obstruction. Herniated organ(s) included: stomach (66.7%), colon (40.0%), small bowel (20.0%), omentum (66.7%), and incarcerated falciform/preperitoneal fat (26.7%). Patients underwent a laparoscopic (13) or robotic (2) repair. The most common (66.7%) method of repair included suturing mesh to the diaphragmatic portion of the defect and securing the anterior-inferior edge to anterior abdominal wall with transfascial sutures and/or tacks. Four patients (26.7%) underwent primary repair. Average defect and mesh size was 37.2 cm2 and 226.4 cm2, respectively. Three patients (20%) underwent a concomitant paraesophageal hernia repair. Mean EBL and length of stay was 31 mL (range 10-125mL) and 2.7 days (range1-7 days). Postoperative morbidity included transient postoperative hypoxemia (2 patients) and pleural effusion (1). There was no mortality, mesh complications or recurrences with a mean follow-up of 36 months.
Conclusions: Morgagni hernias patients were more often older, obese, and women. These hernias remained unrepaired in 87% of patients despite their having had previous abdominal surgery. A laparoscopic or robotic approach offers an effective hernia repair with minimal complications, short hospital stay, and excellent long-term results for both elective and acute operations. Mesh repair, sutured to the diaphragm and sutured/tacked to the abdominal wall, appears to be a very successful means to repair larger defects.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88248
Program Number: P690
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
sages_adbutler_leaderboard