Laparoscopic Mesh Repair Of Diaphragmatic Morgagni Hernia

Abstract

Diaphragmatic hernias of Morgagni were first described in 1769 as anatomical defects in the anterior diaphragm that allow herniation of abdominal viscera into the thorax by Giovanni Battista Morgagni, an Italian anatomist and pathologist. Patients reported to have previous normal radiographs suggest that these hernias may be acquired through a congenital defect in the diaphragm 4. Most hernias of Morgagni are diagnosed late because patients can be asymptomatic or present with vague gastrointestinal and respiratory symptoms and signs. USG has been shown to be useful in assessing diaphragmatic hernias but CT is the most sensitive as it gives excellent anatomical detail on the contents of the hernia and its complications such as strangulation Once diagnosed, the requirement for surgery is largely dependent upon the presentation Repair avoids further complications but it is the timing which is important. Emergency intervention is not always necessary unless there is evidence of strangulation. Laparoscopy is an excellent way to confirm diagnosis and to repair non-complicated hernia of Morgagni. The hernia sac can be easily viewed through the laparoscope. The hernia contents can then be easily reduced once the peritoneum at the perimeter of the defect is incised. The sac is usually not removed; as this may result in massive pneumomediastinum with potential respiratory and circulatory complications.