Laparoscopic Repair of Larrey (Left-Sided Morgagni) Hernia: Technical Considerations

Abstract

In 1769, Morgagni described the diaphragmatic hernia carrying his name, whist doing a post mortem on a head injury patient. Independently, Larrey had described a left-sided Banterior sternoscostal^hernia, and so left-sided Morgagni hernia is also known as a Larrey hernia. It is a very rare type of congenital diaphragmatic hernia with an incidence of 1-3%. It is caused by failure of fusion in the anterior portion of the pleuroperitoneal membrane resulting in retrosternal defect in the diaphragm. Although infants present with recurrent respiratory infections, they can often go unnoticed for several decades. In this case report, we present a 48-year-old male, diagnosed with Larrey hernia who underwent successful total laparoscopic suture repair and Meshplasty. The sac contents were reduced, and the sac was not excised. The edges were approximated, and the mesh was placed to widely cover the defect and suture to the abdominal wall all around. Relevant literature and technical considerations are discussed in this article.

Larrey diaphragmatic hernia in an adult

“…It occurs as a consequence of a failure of fusion in the anterior portion of the . Six months after the operation control computed tomography scan was normal pleuroperitoneal membrane, resulting in the appearance of the left-sided defect in the retrosternal part of the diaphragm, called "Hiatus Larrey, " or the left-sided sternocostal triangle [1]. It was named after the surgeon of Napoleon Bonaparte, Dominique Jean Larrey (1766-1842), who first described it in 1829, while analyzing the alternative ways in the treatment of pericardial tamponade [4].…”

“…laparoscopic or thoracoscopic approach. The well-known advantages of the minimally invasive treatment, including the faster postoperative recovery, as well as the shorter hospitalization period and minimal scarring, urged an increased number of surgeons to treat the patients in this manner in the last several years [1,14]. The robotic surgery, whether transabdominal or transthoracic, represents another technological progress with well-recognized advantages: ergonomics, preciseness of instruments, as well as easy operation in narrow spaces [15,16].…”

“…It usually symptomatically manifests later in life. In addition to the leftsided one, there is also a hernia called Morgagni right-sided anterior congenital hernia, which occurs more frequently, in 90% of the cases, and a hernia called Morgagni-Larrey hernia, which is bilateral, and the incidence of which is around 8% (Figure 1) [1,2,3].…”