Zachary Torgersen, MD, Pradeep Pallati, MD, Tommy Lee, MD, Sumeet K Mittal, MD, Robert J Fitzgibbons, MD, Kalyana Nandipati, MD
Creighton University
Background: Morgagni hernias account for less than five percent of all adult diaphragmatic hernias. Laparoscopic repair has become increasingly preferred to the traditional open approach. However, the technique of laparoscopic Morgagni hernia repair is not well reported.
Methods: In this study, a database search was performed for all diaphragmatic and paraesophageal hernias at our tertiary care center from 1/2006 to 4/2012 using appropriate diagnosis and billing codes (CPT). The hospital records were then retrospectively queried and operative reports reviewed. Of 474 total hernias, 15 diaphragmatic hernias were identified (hiatal hernias and paraesophageal hernias were excluded) with five of the Morgagni type. The data variables collected included; patient demographics, preoperative presentation, surgical technique, postoperative outcomes and follow up (clinical and radiological). These data were included in the final analysis.
Case series: Of the five Morgagni hernias identified (age 44-88 years, 3 females and 2 males); three were symptomatic at presentation while the remainder were incidental findings. Symptoms included dyspnea from large hernias with pulmonary compromise, chest pain, and bloody diarrhea. Laparoscopic hernia repair was performed in four patients. One patient had open repair after an incidental defect was discovered on laparotomy for pancreatic cancer resection. Primary repair was performed in three patients and mesh was used in two patients. The technique of primary repair included utilization of a transfascial suture passer to place nonabsorbable U sutures. Mesh repairs were accomplished with a nonabsorbable prosthesis secured by tacking in an onlay fashion. Hernia contents included small bowel (2), large bowel (2), stomach (1), and omentum. One patient required colon resection for incarcerated bowel. After a minimum follow-up of 6 months, there was no evidence of recurrence. One patient continued to have dyspnea postoperatively and was subsequently diagnosed with myasthenia gravis allowing for an uneventful recovery with appropriate medical therapy.
Summary: Morgagni hernias are an uncommon type of diaphragmatic hernias and may present with atypical chest pain and dyspnea. Laparoscopic repair of Morgagni hernias is feasible. In selected patients primary repair can be performed utilizing transfascial suture technique with satisfactory outcome.
Session: Poster Presentation
Program Number: P309