Minimal Access Surgical Repair of Morgagni Hernia: The Fate of the Unresected Hernia Sac

Abstract

Treatment of retrosternal diaphragmatic (Morgagni) hernia is composed of a simple surgical closure of the retrosternal opening either conventionally by open abdominal or thoracic approaches, or more recently, by using minimal access surgery (MAS). Clinical experience using the latter approach is very limited in children. Removal of the hernia sac is a controversial issue, since the sac is said to carry the risk of cyst formation or show spontaneous resolution. This issue represents a 7-year-old boy with Morgagni hernia that was successfully repaired by the MAS approach. The hernia sac was not resected because of adhesion to the adjacent tissues. The patient was readmitted with fluid accumulation within the remaining sac 2 months after the operation. A complete spontaneous resolution was observed within 2 months under conservative follow-up. To our knowledge, the temporary complication described in this paper has not been published in the literature.

Laparoscopic repair of diaphragmatic Morgagni hernia in children: review of 3 cases

“…A rather controversial issue concerns the necessity for removal of the hernia sac [2,[12][13][14][15][16]. Attempts at resection of the sac may lead to inadvertent incision of the pericardium or pleura.…”

“…The fear of development of a fluid-filled retention cyst does not seem justified. Furthermore, cyst formation has been shown to be treatable using conservative measures [14].…”

Endoscopic Repair of Late-Presenting Morgagni and Bochdalek Hernia in Children: Case Report and Review of the Literature

“…MHs were approached laparoscopically in all but 1 of the 30 cases reviewed, [14][15][16][17][18][19][20][21][22][23] and this one case was converted to laparoscopy due to the difficulty in dissecting the defect. 24 The suturing technique varies with the surgeon's preference.…”

“…The incidence of intra-and postoperative complications is very low: one conversion from thoracoscopy to laparoscopy, 24 one conversion to open laparotomy, 23 one port site hernia, 16 and one fluid collection within the sac. 20 In the adult population, intestinal obstruction, cardiac tamponade, diaphragmatic paralysis, and recurrent herniation have been described. 25 Resection of the hernia sac seems an important detail of the surgical strategy and is a key step of the open technique.…”

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

“…13 The defect itself may be closed either by primary suture closure, primary placement of a mesh, or by a combination of both. 9,14 In this work, I performed laparoscopic repair of MH using the full thickness of the anterior-abdominal wall to the posterior diaphragmatic rim, with extracorporeal knot tying in the subcutaneous tissue without the need of a mesh in all cases.…”