Abstract
PurposeMorgagni−Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial treatment modality is low. Nevertheless, with increasing experience in minimally-invasive surgery, the literature proves the laparoscopic approach as being safely feasible. However, knowledge on the disease as well as treatment options are based on single surgeon’s experiences and small case series in the literature.MethodsRetrospective single-center analysis on adult patients (≥ 18 years) with MLH from 01/2003 to 06/2019 regarding symptoms, hernia sac contents, surgical technique and perioperative outcome.Results4.0% of diaphragmatic hernia repair procedures were performed for MLH (n = 11 patients). 27.3% of these patients were asymptomatic. Dyspnea or gastrointestinal symptoms were frequently observed (both in 45.5% of the patients). Colon transversum (63.6%), omentum majus (45.5%) and/or stomach (27.3%) were the most common hernia sac contents. Correct diagnosis was achieved preoperatively in 10/11 patients by cross-sectional imaging. All procedures were performed by trans-abdominal surgery (laparotomy in four and laparoscopy in seven patients). All hernias were reinforced by mesh after primary closure. No differences were observed in the perioperative outcome between patients who underwent hernia repair by laparotomy versus laparoscopy. Pleural complications requiring drainage were the most common postoperative complications.ConclusionMLH repair seems to be safely feasible by laparoscopic surgery. The benefit of mesh augmentation in MLH repair is not clear yet. In contrast to the current literature, all patients in this study received mesh augmentation after primary closure of the hernia. This should be evaluated in larger patient cohorts with long-term follow-up.
Highlights
Morgagni−Larrey hernias (MLH) are the most common congenital defects in the anterior, parasternal portion of the diaphragm
Hernia (2021) 25:479–489 prospectively conducted trials or larger retrospective studies with a long-term follow-up of the patients after MLH repair are available from the current literature, nor recommendations for surgical treatment of adult patients with MLH are obtained from respective medical societies
Questions may arise for the treating surgeon regarding the appropriate surgical approach, closure technique of the hernia or—in accordance with the hiatal hernia repair—if a mesh augmentation should be performed after primary suture of the hernial orifice
Summary
Morgagni−Larrey hernias (MLH) are the most common congenital defects in the anterior, parasternal portion of the diaphragm. The incidence of these non-traumatic retrocostoxiphoid hernias is estimated to be approximately 1–5% of all types of congenital diaphragmatic hernias and remains even more uncommon in adult patients [1,2,3]. Hernia (2021) 25:479–489 prospectively conducted trials or larger retrospective studies with a long-term follow-up of the patients after MLH repair are available from the current literature, nor recommendations for surgical treatment of adult patients with MLH are obtained from respective medical societies.
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