Two Trocar Laparoscopic Repair of Morgagni Hernia in Infant and Childhood: Simplified Technique

Abstract

Purpose: Morgagni hernia (MH) is a rare entity that accounts for less than 6% of all surgically treated diaphragmatic hernias in pediatric age group. They are mostly asymptomatic and discovered incidentally. Open surgical repair has been the gold standard in all cases. However, since the introduction of minimal access surgery, different laparoscopic techniques of MH repair have been reported. Most of them are reporting on few cases and the immediate outcomes. I report one of the largest experiences to date assessing the safety and efficacy two trocars laparoscopic repair of MH in children with more emphasis on the short-term outcomes, such as the recurrence, conversion rate, operative, postoperative complications and the fate of the hernia sac. Patients and methods: Fifteen children with MHs underwent primary laparoscopic repair by placement of U-shaped, nonabsorbable sutures through the full thickness of the anterior abdominal wall incorporating, the posterior rim of the defect, and returning back out through the anterior abdominal wall with the sutures tied in the subcutaneous tissue using the Storz port closure needle and without hernia sac excision, no insertion of chest tube or drain. Results: A total of 15 patients with MH were operated upon. There were 10 males and 5 females. Left-sided MH was present in five cases (33%), right-sided MH was present in seven cases (47%) and three bilateral MH (20%). Male-female ratio was 2:1. Intraoperative and postoperative analgesia requirement was minimal. All operations were completed laparoscopically. None of the patients developed intraoperative or postoperative complications. The maximum follow-up was 48 months (mean, 20 months). All patients are in good health without recurrence or significant sac residual. Conclusion: This easy save technique of MH repair is reducing the operative time and postoperative hospital stay. Also it is minims the need of postoperative analgesia. The hernia sac excision or not is not affecting the outcome.