Minimally invasive repair of Morgagni hernia – A multicenter case series

Abstract

Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

Technical standardization of laparoscopic repair of Morgagni diaphragmatic hernia in children: results of a multicentric survey on 43 patients

“…An italian physician Gian Battista Morgagni firstly described retrosternal CDH through the right sternocostal triangle, in an adult stonecutter, who died for strangulated herniated colon. After this report, this kind of hernia bore his name [14]. As for the age of CMDH diagnosis, there are recent retrospective studies on CMDH, mostly representing adult data and only few series focused on children [4][5][6][7][8][9].…”

“…In the majority of cases, patients with CMDH are asymptomatic, and the pathology is often diagnosed incidentally during a chest X-ray performed for other indications [1]. Rarely patients present symptoms, such as respiratory problems or abdominal pain, and exceptionally the diagnosis is made for a complicated CMDH, usually with an intestinal obstruction [14]. Patients affected by CMDH can present associated malformations: Chromosomal anomalies, mainly Down syndrome, are frequent findings in these patients as well as the presence of other associated congenital malformations such as congenital heart disease, chest wall deformities and intestinal malrotation [2,3].…”

“…Analyzing the international literature of the last 10 years [10][11][12][14][15][16][17][18][19][20][21], our series is one of the largest ones published. The recurrence rates reported ranged between 9% and 42%; however, it is 0% in the majority of the series.…”

An Incidental Discovery of Morgagni Hernia in an Elderly Patient Presented with Chronic Dyspepsia

“…The recurrence rate of Morgagni hernias is not clear, with about 2-15% of recurrent cases after surgery due to remnant sac or absorbable sutures. 13 A search of PubMed using the terms "Morgagni hernia"…”

Hernia of Morgagni Presenting as Constipation in a 65-Year-Old Male

“…The abdominal approach is preferred unless the diagnosis is uncertain. Recurrent rates of 2%-15% postoperatively are reported due to the remnant pouch or otherwise [9]. Only recently has Arevalo, et al reported successful minimally invasive management of Morgagni hernia with robotic use [10].…”