Management of Morgagni's Hernia in the Adult Population: A Systematic Review of the Literature

Abstract

Background Morgagni's hernia (MH) is defined by the protrusion of abdominal viscera through an anterior retrosternal diaphragmatic defect. The objective of this study was to systematically review current literature on MHs in adult population and assess their clinical characteristics and therapeutic approach. Methods PubMed and Cochrane bibliographical databases were searched (last search: 15 th January 2021) for studies concerning MHs. Results Inclusion criteria were met by 189 studies that included 310 patients (61.0% females) with an age of 57.37 ± 18.41 (mean ± SD) years. Pulmonary symptoms, abdominal pain, and nausea-vomit were among the most frequent symptomatology. MHs were predominantly right-sided (84.0%), with greater omentum (74.5%) and transverse colon (65.1%) being the most commonly herniated viscera. The majority of cases underwent an open procedure, while 42.3% of patients had a minimally invasive procedure. Abdominal approach was mostly preferred, while a thoracic one was chosen at 20.6% of cases and a thoracoabdominal at 3.2%. Thirty-day postoperative complications were recorded at 29 patients and 30-day mortality was 2.3%. Conclusions MH is a rare type of congenital diaphragmatic hernia which rarely manifests in adult population with atypical pulmonary and gastrointestinal symptoms. Surgery is the gold standard for their management. Open surgical approach is preferable in emergency cases, while laparoscopic surgery is favored in elective setting and is associated with shorter hospitalization. Further studies are crucial in order to elucidate etiology and optimal therapeutic approach.

Non-operative management of a large Morgagni hernia—an alternative approach?

“…Nearly all cases of MH are now identified during embryological development on routine ultrasound scans at 18–22 weeks, with diagnosis in adulthood being extremely rare [ 5 , 6 ]. A systematic review by Katsaros et al.…”

“…A systematic review by Katsaros et al. identified 310 reported adult cases of MH from 1949 to 2020 [ 5 ]. In this paper, the average age at diagnosis was 57 years, with a female predominance (61%).…”

“…Of CDH cases diagnosed in adulthood, only 10–28% are asymptomatic, primarily diagnosed incidentally on CT and X-ray imaging [ 5 , 7 ]. If symptomatic, patients commonly present with abdominal pain (37%), shortness of breath (36%) and bowel obstruction (20%) [ 7 ].…”

“…and Horton et al. recommend surgical repair for all patients with MH due to concerns about intestinal strangulation; however, there is a paucity of data [ 5 , 7 ]. Surgical repair can be performed from the abdominal or thoracic sides, and both open and minimally invasive techniques have been described [ 5 , 7 ].…”

Morgagni hernia presented as Sudden dyspnea in 70 years old man: a case report

“…Primary closure is generally used for more minor defects, but mesh may be required for more significant defects [ 7 ]. The postoperative complications include pericardial tamponade, lung embolus, collapsed lung, wound seroma, and haematoma [ 9 ]. Our patient was passed the postoperative period without any complications.…”