Laparoscopic Morgagni hernia repair in children: systematic review

Abstract

This study performed a systematic review on procedures, instruments, techniques, and outcomes of laparoscopy in children with Morgagni hernias (MH). The literature was reviewed for articles online on PubMed with search terms “laparoscopy”, “Morgagni”, “hernia”, and “children”. The inclusion criteria included articles only in English, and in the pediatric age group of 0–18. Articles that did not meet the inclusion criteria were excluded. The literature search from 1997 to 2019 revealed 32 articles that met the inclusion criteria. A total of 201 children were analyzed for laparoscopic repair of MH with age range 1 month–14 years. Sixty-four children had chest infections and n = 58 were asymptomatic. Laparoscopic procedures were carried out using a single-port technique (n = 9) or 3 ports (n = 145). There was a 30° scope preference in 47 children. In 97 children, the falciform ligament was divided. The preferred technique was primary closure using either intracorporeal (n = 18) or extracorporeal (n = 183) knot tying techniques, using non-absorbable sutures in all but four cases. Resection of the sac was reported in 42 patients. However, in 21 patients, there were large-size defects that required patch repairs. Some surgeons (n = 8) opted for suture devices. Robotic repairs were performed in 4 children. There were 7 conversions. Postoperative complications included 10 recurrent hernias, 3 residual sacs, and 1 port site hernia. With regards to associated conditions, 30 children had Down’s syndrome, 13 other chromosome abnormalities, 16 cardiac malformations, and 4 gastroesophageal reflux disease. There was 1 lethal outcome due to respiratory complications. Repair of MH is preferred only through the laparoscopic approach. Almost one-third of the patients have an associated condition. Repairs are associated with patches in one-tenth cases. Conversion in repairs is extremely low and is around 3.5%. Recurrence after laparoscopic approach is estimated to 5%.