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Surgical Endoscopy

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01-01-2022 | Diaphragmatic Hernia

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

Authors: Elisabeth Leeflang, Jesse Madden, Anna Ibele, Robert Glasgow, Ellen Morrow

Published in: Surgical Endoscopy | Issue 1/2022

Abstract

Background

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.

Methods

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.

Results

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 1.3 days (range 0.5–5.5 days). At a median follow-up of 10.9 months (IQR 8.0–41.5 months), all symptoms attributed to the hernia had resolved. No recurrences were identified.

Conclusions

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.

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Title: Laparoscopic management of symptomatic congenital diaphragmatic hernia of Morgagni in the adult
Authors: Elisabeth Leeflang
Jesse Madden
Anna Ibele
Robert Glasgow
Ellen Morrow
Publication date: 01-01-2022
Publisher: Springer US
Keywords: Diaphragmatic Hernia
Diaphragmatic Hernia
Published in: Surgical Endoscopy / Issue 1/2022
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08259-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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