Laparoscopic Morgagni hernia repair on an infant using percutaneous suturing technique

Abstract

Morgagni Hernias (MH) are anterior retrosternal diaphragmatic defects that necessitate surgical repair due to risk of incarceration. Historically, all repairs were performed through open surgery, but minimally invasive repair via abdominal or thoracic approach is becoming more commonly practiced. Closure of the diaphragmatic defect with the minimally invasive surgical technique is often completed using interrupted intracorporeal sutures. We present a case report of a 12-month-old male with asymptomatic MH, who underwent a novel laparoscopic approach to repair. The procedure began using three trocars to resect the hernia sac in a traditional fashion. Subsequently, the diaphragmatic defect was repaired using the subcutaneous endoscopically assisted suturing (SEAS) technique along the abdominal wall, similar to what was described by Harrison et al. for endoscopically-assisted inguinal hernia repair. The procedure was completed in 54 minutes. The patient tolerated the operation well, was discharged home post-operative day one and had no evidence of recurrence after five months. Laparoscopic repair of MH with percutaneous suturing is a novel approach that allows for safe, expeditious, and precise repair of a traditionally challenging procedure in small children with improved cosmetic outcomes.