Laparoscopic Concomitant Sleeve Gastrectomy and Repair of a Morgagni Larrey Hernia - Case Report

Abstract

Anterior diaphragmatic hernias are very rare surgical entities, scarce in symptoms, which occur through openings of the costal and sternal fascicules of the diaphragm. First described by Giovanni Battista Morgagni, in 1769, they are known under many names: Morgagni, Morgagni-Larrey. These hernias can develop in the left hemidiaphragm, right hemidiaphragm or bilateral. The preferred treatment when available is the laparoscopic suture of the defect. We present the case of a 52 years old female patient, with morbid obesity (BMI = 44.10 kg/m²) and Morgagni hernia. Other associated pathologies of the patient were high blood pressure, autoimmune thyroiditis, and sleep apneea. The initial diagnosis of diaphragmatic hernia was made a year earlier at a CT investigation. Laparoscopic sleeve gastrectomy and suture of the diaphragmatic defect were achieved without incidents during one single surgical intervention. A drainage tube was placed in the remaining cavity of the hernia. The hernia sac was conserved and used to reinforce the defect. The concurrent suture of the diaphragmatic hernia and sleeve gastrectomy do not increase the postoperative morbidity. The recovery was uneventful, thus the patient was spared a second surgical intervention . If present, these hernias are quickly identified due to the fact that laparoscopy allows a through exploration of the diaphragm. When diagnosed these defects should be repaired by suture due to the fact that they can cause life threating complications to the patient such as intestinal obstruction or gastro-intestinal bleeding if elements of the digestive tract are incarcerated in the defect.