Laparoscopic Morgagni Hernia Repair Research Articles

The surgical treatment of Morgagni hernias in adults: a systematic review for the standardization of laparoscopic surgical repair.

A Morgagni hernia is a congenital diaphragmatic hernia that is rarely diagnosed in adults, and the technique for its repair has not yet been standardized. This review will give an overview of the different laparoscopic methods reported by other authors, highlighting the key points indicating a good repair to help standardize the technique. A systematic review of the available articles on PubMed was conducted according to PRISMA 2020 by two authors independently in May 2022. Only articles written in English were included. A total of 180 case reports of laparoscopic Morgagni's hernia repair procedures were found; direct repair was performed in 59 patients, mesh was used in 119 patients, and mesh was not used in 2 patients. The hernia sac was removed in 71 patients, and the defect was closed before mesh placement in 49 patients. Nonabsorbable, dual or biologic mesh was used. The mean operative time was 92.65 min for direct repair and 84.11 min for mesh repair. One recurrence was reported in the direct repair series. The optimal method of repair has not yet been identified. The laparoscopic approach is associated to fewer complications and facilitates a faster recovery than the open approach. Several manoeuvres have been reported to help surgeons, who are not trained in laparoscopic knotting, perform extracorporeal knotting. Mesh should be placed when tension is too high after a direct repair or when primary closure cannot be achieved.

A novel scarless laparoscopic method for morgagni hernia repair.

Morgagni hernia (MH) is a rare congenital defect of the diaphragm. Although the various surgical method has been proposed, there is no surgical consensus. In this study, we aimed to report the outcome of the patients that underwent surgery which is completed using a single port laparoscopic-assisted transabdominal closure of MH. This is a retrospective analysis of 18 pediatric patients who underwent novel laparoscopic MH repair at a single tertiary pediatric hospital between March 2018 and December 2020. Of the 18 patients, 72% (n = 13) were male and 28% (n = 5) were female. The symptoms at admission included repeated chest infection (39%), dyspnea (33%), vomiting (17%), and abdominal pain (22%). The colon (78%) was the most frequently herniated organ. Hernias were bilateral, on the left, and on the right in seven, four, and seven cases, respectively. All surgical interventions were completed within 25-50 min. All patients started enteral feeding within 24 hours. All patients were discharged within 1-3 days without any complications. The mean follow-up period was 27 months. In conclusion, our method is characterized by a shorter operation time, early return to feeding, early discharge, excellent cosmetic results, low cost, and low recurrence rate. Further prospective trials are needed to compare our novel scarless technique to other methods.

Laparoscopic Morgagni Hernia Repair without Sutures Using Only Composite Mesh in Patients with Large Defects

In this report, we present the clinical characteristics and surgical outcomes of three pediatric patients who presented to our clinic with congenital Morgagni hernia and were treated with laparoscopic surgery using only mesh.

Laparoscopic management of symptomatic congenital diaphragmatic hernia of Morgagni in the adult.

Currently, there is a relative paucity of literature regarding the management of symptomatic congenital diaphragmatic hernia of the foramen of Morgagni in the adult. This study aims to describe our unique surgical technique and outcomes in adult patients undergoing laparoscopic repair of symptomatic Morgagni hernia. This is a retrospective review of adult patients from 2003 to 2020 who underwent a laparoscopic Morgagni hernia repair at our institution. All patients underwent a similar laparoscopic approach, utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect and mesh reinforcement with permanent mesh if the primary repair was subjectively under tension. The study population consisted of 12 consecutive patients with a Morgagni hernia. Patients presented with a variety of symptoms attributed to the hernia, including pain 83% (n = 10), respiratory symptoms and shortness of breath 58% (7), and gastrointestinal obstruction 25% (3). Other complaints included: nausea 33% (4), reflux 50% (6), early satiety 8% (1), palpitations 16% (2), a gurgling sensation in the chest 8% (1), and weight loss 8% (1). Primary repair was possible in all patients following complete reduction of hernia contents including the hernia sac. Mesh reinforcement was used in 5 of 12 patients. Average surgical operative time was 93 (± 37) min. Median length of stay was 1.3days (range 0.5-5.5days). At a median follow-up of 10.9months (IQR 8.0-41.5months), all symptoms attributed to the hernia had resolved. No recurrences were identified. Adults with symptomatic Morgagni hernia should undergo surgical repair. A laparoscopic approach utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect (when possible), with or without mesh reinforcement can be performed safely and effectively.

Laparoscopic repair of giant Morgagni hernia by direct suturing with V-Loc.

Morgagni hernias present technical challenges. The laparoscopic approach for repair was first described in 1992; however, as these hernias are uncommon in adult life, few data exist on the optimal method for surgical management. The purpose of this study was to analyze a method for laparoscopic repair of Morgagni giant hernias using laparoscopic primary closure with V lock (Medtronic, Covidien). This case series describes a method of laparoscopic Morgagni hernia repair using primary closure. In all patients, a laparoscopic transabdominal approach was used. The content of the hernia was reduced into the abdomen, and the diaphragmatic defect was closed with a running laparoscopic suture using a self-fixating suture. Clips were placed at the edges of the suture to secure the pledged sutures to both the anterior and posterior fascia. Demographic data such as BMI and operative and postoperative data were collected. Retrospectively collected data for 9 patients were analyzed. There were 1 (11.1%) males and 8 (88.8%) females. The median BMI was 29.14±52 kg/m2. The median operative time was 80±25 minutes. There were no intraoperative complications or conversions to open surgery. Patients began a fluid diet on the first postoperative day and were discharged after a median hospital stay of 3±1.87 days. In a median follow-up of 36 months, we did not observe any recurrences. Transabdominal laparoscopic approach with primary closure of the diaphragmatic defect is a viable approach for the repair of Morgagni hernia. In our experience, the use of laparoscopic transabdominal suture fixed to the fascia allowed the closure of the defect laparoscopically with minimal tension on the repairs.

Acquired Morgagni diaphragmatic hernia and pericardial hernia after cardiac surgery

Acquired anterior diaphragmatic hernia (ADH) is usually the result of thoracic trauma. Acquired Morgagni-type anterior diaphragmatic hernia is a rare complication after cardiac surgery, especially with associated pericardial hernia. We will present a patient with acquired Morgagni-type hernia and pericardial hernia presumably after previous cardiac surgery successfully treated with laparoscopic Morgagni hernia reduction and repair with mesh onlay as well as prophylactic laparoscopic appendectomy, open epigastric hernia repair, and open umbilical hernia repair.

Open Versus Laparoscopic Approach for Morgagni's Hernia in Infants and Children: A Systematic Review and Meta-Analysis.

The laparoscopic repair of Morgagni's hernia (MH) has been reported to be safe and feasible. However, it is still unclear whether laparoscopy is superior to open surgery in repairing MH. Using a defined search strategy, three investigators independently identified all comparative studies reporting data on open and laparoscopic MH repair in patients <18 years of age. Case reports and opinion articles were excluded. Meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3. Data are expressed as mean ± SD. Systematic review - Of 774 titles/abstracts screened, 51 full-text articles were analyzed. Three studies were included (92 patients), with 53 (58%) open approaches and 39 (42%) laparoscopy. Meta-analysis - The length of surgery was shorter in laparoscopy (50.5 ± 17.0 min) than in open procedure (90.0 ± 15.0 min; P < .00001). Laparoscopy shortened the length of hospital stay (2.1 ± 1.4 days) versus open surgery (4.5 ± 2.1 days; P < .00001). There was no difference with regards to complications (laparoscopy: 8.8% ± 5.5%, open: 9.4% ± 1.6%; P = .087) and recurrences (laparoscopy: 2.9% ± 5.0%, open: 5.7% ± 1.8%; P = .84). Comparative studies indicate that laparoscopic MH repair can be performed in infants and children. Laparoscopy is associated with shortened length of surgery and hospital stay in comparison to open procedure. Prospective randomized studies would be needed to confirm present data.

Comment to: Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement. Ryan JM, et al.

Comment to: Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement. Ryan JM, et al.

Pericardial Effusion Can Be a Critical Complication After Laparoscopic Hernia Repair Using Mesh and Stapler for Morgagni Hernia

Several cases of Morgagni hernia have recently been treated with laparoscopic mesh repair, which is reported to have fewer complications and to be less invasive. Here we describe a case of a laparoscopic Morgagni hernia repair treated with mesh that progressed to heart failure due to pericardial effusion 2 months after hospital discharge. A 78-year-old woman was incidentally found to have a Morgagni hernia during a routine chest X-ray. The laparoscopic Morgagni hernia repair was performed using Composix mesh and an ENDOPATH EMS stapler. The Composix mesh was gently attached to the surface of the diaphragm using the ENDOPATH EMS stapler. She was discharged from the hospital on the seventh postoperative day without any adverse events. However, 2 months later, she developed dyspnea due to heart failure secondary to a pericardial effusion. Pericardial drainage was performed during her hospitalization, and she was discharged 7 days later. No recurrence of either the pericardial effusion or the Morgagni hernia has been detected since the pericardial drainage. Clinicians may need to be aware of the risk of pericardial effusion in these cases, even if there has been no damage to the diaphragm or epicardium.

Single-Incision Laparoscopic Morgagni Hernia Repair in an Adult

Introduction: This is a case report of a single-incision laparoscopic Morgagni hernia repair. We discuss our initial experience with this technique. Case Description: A 63-year-old man elected to undergo a single- incision laparoscopic Morgagni hernia repairs after diagnostic imaging showed a large fat containing right diaphragmatic hernia. The patient's only preoperative symptom was periodic right sided chest pain. The procedure was accomplished through a 2 cm vertical umbilical incision using a Covidien SILS ® port and a combination of straight and articulating laparoscopic instruments. Total operative time was 119 minutes. The patient was discharged home on post-operative day one. The patient tolerated the procedure well without any intraoperative complications or post-operative complications over18 months of follow-

Laparoscopic morgagni hernia repair using single-site umbilical and full-thickness abdominal wall repair: Technical report of two cases

Single incision laparoscopic surgery is used in many centres for routine cases such as appendectomy, splenectomy and cholecystectomy. Morgagni hernias are uncommon and account for 1-2% of all congenital diaphragmatic hernia. We report our first laparoscopic repair of two Morgagni hernias, using a single umbilical incision and full-thickness abdominal wall repair with standard straight laparoscopic instruments. Operative time was short and compared favourably with the laparoscopic repair.

Recurrence rate of Morgagni diaphragmatic hernia following laparoscopic repair

Morgagni diaphragmatic hernia can be repaired laparoscopically. The aim of this study is to evaluate the outcome of this minimally invasive approach. A retrospective review was conducted on all consecutive children who underwent repair of Morgagni hernia from January 2002 to December 2011 in our hospital. Data are expressed as median (range). There were 12 children with Morgagni hernia. Age at surgery was 7.5months (2-125). Associated malformations were present in 7 children (58%). All children underwent initial laparoscopic approach. Two children (16%) underwent conversion to open surgery. The hernia was closed primarily in 11 children (92%), using a polyester patch in 1 (8%). There were no intraoperative or immediate postoperative complications. Five children (42%), all repaired initially without a patch, had a recurrence of the Morgagni hernia. The repair of the recurrent hernia was performed laparoscopically in four out of the five children, and a patch was used in two patients with no further recurrences or complications. There is a high rate of recurrence after laparoscopic Morgagni hernia repair. This is exclusively associated with laparoscopic repair without patch, and it is in contrast with the low recurrence rate reported previously. More frequent use of patch may be beneficial.

Concurrent Laparoscopic Morgagni Hernia Repair and Sleeve Gastrectomy

The Morgagni-type anterior diaphragmatic hernia is a congenital defect that is a very uncommon hernia presenting in an adult. Surgical repair is usually recommended upon diagnosis and often requires synthetic mesh for a durable, tension-free repair. The use of synthetic mesh concurrently with several of bariatric operations is controversial owing to the potential for mesh infection. In this report we describe a laparoscopic repair of a symptomatic Morgagni hernia with synthetic mesh, concurrently with sleeve gastrectomy, in a morbidly obese man. The patient was a 58-year-old man with a body mass index of 48 kg/m(2) and associated co-morbid conditions that included obstructive sleep apnea, hypertension, hyperlipidemia, impaired fasting glucose, and osteoarthritis. He was diagnosed with Morgagni hernia with exertional dyspnia. He underwent concurrent laparoscopic Morgagni hernia repair with mesh and sleeve gastrectomy. At 2 months after surgery the patient was doing well and tolerating solid foods, and his percentage excess weight loss was 35%. He was exercising regularly and had no exertional dyspnea. Laparoscopy is an attractive approach to performing multiple intra-abdominal procedures concurrently. The Morgagni hernia repair with mesh can be performed safely and effectively using a laparoscopic approach. This can be performed concurrently with bariatric surgery in the morbidly obese.

Laparoscopic repair of Morgagni diaphragmatic hernia in infants and children

Purpose Removal of the hernia sac for Morgagni diaphragmatic hernia repair in infants and children is a controversial issue. In our series, we elected not to excise the sac in all the cases. Methods Nine children with retrosternal (Morgagni) hernias underwent primary laparoscopic repair without excision of the hernia sac, and we analyzed our results, complications, and outcome. Results Between January 2007 and March 2011, nine children, comprising five boys and four girls, with Morgagni hernia underwent repair laparoscopically at our hospital. The mean age of the children was 15.1 months (range, 3–38 months), mean operative time was 50.5 min, and mean hospital stay was 3.6 days. There were no intraoperative or postoperative complications. The mean follow-up time was 32.8 months (range, 6–54 months). There were no recurrences. All patients had complete obliteration of the residual cavity. Conclusion Laparoscopic closure of the defect by suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall without excision of the hernia sac is safe and effective in repairing Morgagni hernia without any risk accruing from leaving the hernia sac intact. Keywords: laparoscopic Morgagni hernia repair, Morgagni diaphragmatic hernia, retrosternal diaphragmatic hernia

Morgagni Hernia Repair in a Small Child Using da Vinci Robotic Instruments – A Case Report

The recently introduced use of robotic surgery in minimally invasive surgery procedures facilitates several steps in the operative procedure. We report the first case of a robot-assisted laparoscopic repair of a Morgagni hernia using the da Vinci Surgical System from Intuitive Surgical (Sunnyvale, CA, USA) in a 7.8 kg 18-month-old child. Four trocars were used to gain access to the abdomen. The robot-enhanced instruments were used to close the hernia defect with interrupted, absorbable sutures, using intracorporeal knot tying. The operation was completed laparoscopically without a patch. The total setup time for the robotic system was 35 minutes including draping. The operating time at the robotic console was 80 minutes. The child tolerated an oral intake the day after surgery and was discharged home on the third postoperative day. Robot-assisted laparoscopic Morgagni hernia repair is feasible in small children.

Use of a Prosthetic Patch for Laparoscopic Repair of Morgagni Diaphragmatic Hernia in Children

Morgagni hernias are well suited to laparoscopic repair. A primary suture closure may result in tension on the repair, thereby predisposing the patient to a recurrence. A prosthetic patch (PP) can be used to provide a tension-free repair. In this study, we reviewed our experience with the laparoscopic PP repair of Morgagni hernias in children. A retrospective chart review of all patients undergoing a laparoscopic Morgagni hernia repair using a PP was undertaken between November 2002 and January 2006. Outcome measures included age, gender, defect size, use of mesh, and outcome. The time of follow-up was from 6 to 37 months. Seven (7) patients (6 male, 1 female) underwent a laparoscopic repair of Morgagni hernia during this time period. Six (6) patients had a congenital hernia, and 1 patient was thought to have an iatrogenic hernia following a sternotomy for heart surgery. Defect size ranged from 4 to 7 cm in maximum dimension. All operations were completed laparoscopically, no patients presented with recurrence, and no PP complications were encountered. The laparoscopic repair of Morgagni hernia using a PP can be performed with relative ease and with a positive outcome, and may prevent future recurrence by effecting a tension-free repair.

Laparoscopic Morgagni Hernia Repair in Children Using Robotic Instruments

Robotic surgery enhances minimally invasive surgery through tremor filtration, motion scaling, indexed movement, articulation, and improved ergonomics. We report 2 cases of computer- assisted, robot-enhanced, laparoscopic repair of Morgagni hernia in a 23-month-old weighing 10.2 kg and a 5-year-old weighing 21.6 kg. Four 5 mm trocars were used to gain access to the abdomen. In the first case, standard laparoscopic instruments were used to dissect the liver from the rim of the defect and then reduce the hernia. In the second, robotic instruments were used for this dissection. In both cases, the robot- enhanced instruments were used to close the hernia defects with interrupted, nonabsorbable suture, using intracorporeal knot tying. Both cases were completed laparoscopically without a patch. The robotic system took 9 minutes to set up and drape. The average operative time was 227 minutes. The older child tolerated oral intake the day of surgery and went home the following day. The younger child tolerated oral intake and went home on postoperative day 2. Robot-assisted laparoscopic Morgagni hernia repair is feasible.

Laparoscopic Repair of Morgagni Diaphragmatic Hernia in Children: Technical Challenges and Results

Purpose: We report our preliminary experience with laparoscopic repair of anterior midline (Morgagni) diaphragmatic hernia and identify technical issues. Methods: Four consecutive children undergoing laparoscopic Morgagni hernia repair over 3 years were reviewed. Results: The ages ranged from 13 months to 13 years. Three were found incidentally, and one presented with sudden onset of left side chest pain; none had obstructive symptoms. At operation the hernia contained omentum in all cases and bowel in three cases. All four underwent primary laparoscopic repair with interrupted nonabsorbable sutures. A small residual eventration was left along the edge of the pericardium in the one patient with a sac. The patient who presented with chest pain was found grossly and histologically to have acute appendicitis within the left chest, requiring dissection of the inflamed viscera from the mediastinum and chest wall; laparoscopic appendectomy was also done. Median time to full diet was 3 days, morphine was given for a median of 36 hours, and median postoperative hospital stay was 4.5 days. There were no complications, and no cases were converted. Followup chest radiograph demonstrated complete resolution of the hernia in three patients, and a small amount of residual bowel in the unrepaired pericardial portion of the eventration in the other patient. All children remain clinically well. Conclusion: Laparoscopic repair of Morgagni diaphragmatic hernia in children is a safe technique that provides rapid recovery and superior cosmetic results. Many unexpected technical challenges can be managed effectively without converting to an open approach.