Two trocar laparoscopic repair of Morgagni hernia in infant and childhood: simplified technique.

Medhat Ibrahim, MD, Assistant, prof, paediatric, surgery

Pediatric Surgical Unit, Faculty of Medicine, Al-Azhar University, Nasr City, Cairo, Egypt, 11884

Purpose: Morgagni hernia is a rare entity that accounts for less than 6% of all surgically treated diaphragmatic hernias in pediatric age group. They are mostly asymptomatic and discovered incidentally. Open surgical repair has been the gold standard in all cases. However, since the introduction of minimal access surgery, different laparoscopic techniques of Morgagni hernia repair have been reported. Most of them are reporting on few cases and the immediate outcomes. Herein, I report one of the largest experiences to date assessing the safety and efficacy tow trocars laparoscopic repair of Morgagni hernia in children with more emphasis on the short-term outcomes, such as the recurrence, conversion rate, operative, post-operative complications and the fate of the hernia sac.

Methods: Fifteen children with Morgagni hernias underwent primary laparoscopic repair by placement of U shaped, non-absorbable sutures through the full thickness of the anterior abdominal wall incorporating, the posterior rim of the defect, and returning back out through the anterior abdominal wall with the sutures tied in the subcutaneous tissue using the Storz port closure needle and without hernia sac excision, no insertion of Chet tube or drain.

Result: A total of 15 patients with Morgagni Hernia (M.H) were operated upon. There were 10 males and 5 females. Left-sided (M.H) was present in 5 cases (33%), right-sided (M.H) was present in 7 cases (47%) and 3 bilateral (M.H) (20 %). Male-female ratio was 2:1. Postoperative analgesia requirement was minimal. All operations were completed laparoscopically. None of the patients developed intraoperative or postoperative complications. The maximum follow-up was 48 months (mean, 20 months). All patients are in good health without recurrence or significant sac residual.

Conclusion; this easy save technique of (M.H) repair is reducing the operative time, and post-operative hospital stay. Also it is minims the need of postoperative analgesia. The hernia sac excision or not is not affecting the outcome of surgery.


Session: Poster Presentation

Program Number: ETP007

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