1
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Jank M, Boettcher M, Keijzer R. Surgical management of the diaphragmatic defect in congenital diaphragmatic hernia: a contemporary review. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000747. [PMID: 39183804 PMCID: PMC11340723 DOI: 10.1136/wjps-2023-000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 07/15/2024] [Indexed: 08/27/2024] Open
Abstract
Worldwide, 150 children are born each day with congenital diaphragmatic hernia (CDH), a diaphragmatic defect with concomitant abnormal lung development. Patients with CDH with large defects are particularly challenging to treat, have the highest mortality, and are at significant risk of long-term complications. Advances in prenatal and neonatal treatments have improved survival in high-risk patients with CDH, but surgical treatment of large defects lacks standardization. Open repair by an abdominal approach has long been considered the traditional procedure, but the type of defect repair (patch or muscle flap) and patch material (non-absorbable, synthetic or absorbable, biological) remain subjects of debate. Increased experience and improved techniques in minimally invasive surgery (MIS) have expanded selection criteria for thoracoscopic defect repair in cardiopulmonary stable patients with small defects. However, the application of MIS to repair large defects remains controversial due to increased recurrence rates and unknown long-term effects of perioperative hypercapnia and acidosis resulting from capnothorax and reduced ventilation. Current recommendations on the surgical management rely on cohort studies of varying patient numbers and data on the long-term outcomes are sparse. Here, we discuss surgical approaches for diaphragmatic defect repair highlighting advancements, and knowledge gaps in surgical techniques (open surgery and MIS), patch materials and muscle flaps for large defects, as well as procedural adjuncts and management of CDH variants.
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Affiliation(s)
- Marietta Jank
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, Rady Faculty of Heath Sciences, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Surgery, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Richard Keijzer
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, Rady Faculty of Heath Sciences, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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2
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Oumarou M, Panait N, El Khoury E, Hamidou Z, Pinol J, Barila Lompe P, Merrot T, Faure A, Dariel A. Recurrence of anterior congenital diaphragmatic hernia after laparoscopic repair in children. Pediatr Surg Int 2024; 40:166. [PMID: 38954216 DOI: 10.1007/s00383-024-05739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To report our experience with laparoscopic repair of anterior congenital diaphragmatic hernia (CDH) using extracorporeal subcutaneous knot tying and to define recurrence risk factors. METHODS This retrospective unicentric study included children who underwent laparoscopic repair of anterior CDH without patch, using extracorporeal knot tying of sutures passed through the full thickness of the abdominal wall (2013-2020). A systematic review of the literature with meta-analysis was performed using the MEDLINE database since 2000. RESULTS Eight children were included (12 months [1-183]; 10.6 kg [3.6-65]). Among the two patients with Down syndrome, one with previous cardiac surgery had a recurrence at 17 months postoperatively. In our systematic review (26 articles), among the 156 patients included, 10 had a recurrence (none with patch). Recurrence was statistically more frequent in patients with Down syndrome (19.4%) than without (2.5%) (p < 0.0001), and when absorbable sutures were used (50%) instead of non-absorbable sutures (5.3%) (p < 0.0001). CONCLUSION Laparoscopic repair of anterior CDH without patch was a safe and efficient surgical approach in our patients. The use of a non-absorbable prosthetic patch should be specifically discussed in anterior CDH associated with Down syndrome and/or in case of previous cardiac surgery to perform a diaphragmatic tension-free closure.
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Affiliation(s)
- Mamane Oumarou
- Department of Pediatric Surgery, Hôpital Timone Enfants, Assistance Publique des Hôpitaux de Marseille, 264, Rue Saint Pierre, 13385, Marseille, France
| | - Nicoleta Panait
- Department of Pediatric Surgery, Hôpital Timone Enfants, Assistance Publique des Hôpitaux de Marseille, 264, Rue Saint Pierre, 13385, Marseille, France
| | - Eliane El Khoury
- Department of Pediatric Surgery, Hôpital Timone Enfants, Assistance Publique des Hôpitaux de Marseille, 264, Rue Saint Pierre, 13385, Marseille, France
| | - Zeinab Hamidou
- Department of Epidemiology and Health Economy, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Jessica Pinol
- Department of Pediatric Surgery, Hôpital Timone Enfants, Assistance Publique des Hôpitaux de Marseille, 264, Rue Saint Pierre, 13385, Marseille, France
| | - Patricia Barila Lompe
- Department of Pediatric Surgery, Hôpital Timone Enfants, Assistance Publique des Hôpitaux de Marseille, 264, Rue Saint Pierre, 13385, Marseille, France
| | - Thierry Merrot
- Department of Pediatric Surgery, Hôpital Timone Enfants, Assistance Publique des Hôpitaux de Marseille, 264, Rue Saint Pierre, 13385, Marseille, France
| | - Alice Faure
- Department of Pediatric Surgery, Hôpital Timone Enfants, Assistance Publique des Hôpitaux de Marseille, 264, Rue Saint Pierre, 13385, Marseille, France
| | - Anne Dariel
- Department of Pediatric Surgery, Hôpital Timone Enfants, Assistance Publique des Hôpitaux de Marseille, 264, Rue Saint Pierre, 13385, Marseille, France.
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Almutairi MA, Sultan AF, Alariefy AA, Alzahrani NA, Baghaffar AH, Al-Radi OO. Simultaneous repair of diaphragmatic hernia and ventricular septal defect with postoperative complication in a Down syndrome child. J Surg Case Rep 2024; 2024:rjae301. [PMID: 38832060 PMCID: PMC11146207 DOI: 10.1093/jscr/rjae301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
Morgagni hernia (MH) is a rare form of congenital diaphragmatic hernia, typically occurring predominantly on the right side and exhibiting a higher prevalence in females. Usually diagnosed incidentally, MH may coexist with congenital heart defects, chest wall abnormalities and certain genetic syndromes such as Down syndrome. A 4-year-old boy with Down syndrome underwent simultaneous repair of MH and closure of a ventricular septal defect (VSD). A vertical midline sternotomy was performed, and the VSD was repaired using the right atrium approach. Subsequently, MH repair was conducted. Three weeks after the surgery, this patient developed a complete heart block, which lead to the implantation of a VVI pacemaker.
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Affiliation(s)
| | | | | | - Nada A Alzahrani
- Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Abdullah H Baghaffar
- Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - Osman O Al-Radi
- Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
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Okur MH, Aydoğdu B, Azizoğlu M, Arslan S, Bayram S, Basuguy E. Comparison of Single-incision Laparoscopic Percutaneous and Cystoscope Forceps Assisted Morgagni Hernia Repair Techniques. J Pediatr Surg 2024; 59:1089-1093. [PMID: 38220555 DOI: 10.1016/j.jpedsurg.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Our goal was to compare single-incision laparoscopic percutaneous and cystoscope forceps-assisted Morgagni hernia repair techniques. MATERIALS AND METHODS A total of 40 patients were allocated to two groups, each with 20 patients. Group 1: Single incision (port) laparoscopic surgical percutaneous Morgagni hernia repair (with a 5 mm Storz laparoscopic scope entered through the umbilicus). Group 2: Single incision (port) laparoscopic surgical percutaneous Morgagni hernia repair (with an 11 Fr [3.6 mm] cystoscope entered through the umbilicus + using forceps + sac plication, and sac cauterization). In Group 1; the sac was not removed. In group 2; we advanced the forceps through the cystoscope, caught the sac, pushed the needle through the sac, plicated the sac, and then cauterized the sac with Bugbee electrode. RESULTS Of the 40 patients, 70 % (n = 28) were male. The symptoms at admission included repeated chest infections (40 %), dyspnea (30 %), vomiting (22 %), and abdominal pain (22 %). No difference was found between groups in terms of age, gender symptomatology, or associated anomalies. The operation time was shorter in group 2 compared to group 1 (p < 0.05; 25 min vs 40 min). Although there was one recurrence in Group 1, no recurrence was reported in Group 2. The recurrence incidence did not differ between groups (p > 0.05). CONCLUSIONS Cystoscope-assisted repair of Morgagni hernia was found to be superior in terms of safety and shorter operation time. LEVEL OF EVIDENCE Type III. TYPE OF THE STUDY Retrospective study.
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Affiliation(s)
- Mehmet Hanifi Okur
- Dicle University Medical School Department of Pediatric Surgery, Diyarbakır, Turkey.
| | - Bahattin Aydoğdu
- Balıkesir University Medical School Department of Pediatric Surgery, Balıkesir, Turkey
| | - Mustafa Azizoğlu
- Esenyurt Necmi Kadıoğlu State Hospital Department of Pediatric Surgery, Istanbul, Turkey
| | - Serkan Arslan
- Dicle University Medical School Department of Pediatric Surgery, Diyarbakır, Turkey
| | - Salih Bayram
- Artuklu University Medical School Department of Pediatric Surgery, Mardin, Turkey
| | - Erol Basuguy
- Dicle University Medical School Department of Pediatric Surgery, Diyarbakır, Turkey
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5
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Wang C, Liu X, Shu Z, Yin J, Luo Z, Zhou G, Liu B. Single-site laparoscopic ligation of the hernia sac in infants with congenital Morgagni hernia. Front Pediatr 2023; 11:1078244. [PMID: 36896400 PMCID: PMC9989263 DOI: 10.3389/fped.2023.1078244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Background Congenital Morgagni hernia (CMH) is a rare midline defect involving herniation of abdominal viscera into the thoracic cavity through triangular parasternal gaps in the diaphragm. Methods The medical records of three patients with CMH admitted to the Department of Pediatric Surgery at the Affiliated Hospital of Zunyi Medical University between 2018 and 2022 were retrospectively reviewed. Pre-operative diagnosis was based on chest x-ray, chest computerized tomography, and barium enema. All patients were treated with single-site laparoscopic ligation of the hernia sac. Results Hernia repair was successful in all patients (males; age: 14 months, 30 months, 48 months). The average operative time for repair of a unilateral hernia was 20 ± 5 min. Volume of surgical blood loss was 2-3 ml. There was no damage to organs such as the liver or intestines, or to tissues such as the pericardium or the phrenic nerve. Patients were allowed a fluid diet 6-8 h after surgery, and remained on bed rest until 16 h after surgery. No postoperative complications occurred, and patients were discharged on postoperative Day 2 or 3. No symptoms or complications were noted during the 1-48 months of follow-up. Aesthetic outcomes were satisfactory. Conclusions Single-site laparoscopic ligation of the hernia sac provides pediatric surgeons a safe and effective technique for repair of CMH in infants and children. The procedure is straightforward, operative time and surgical blood loss are minimal, recurrence is unlikely, and aesthetic outcomes are satisfactory.
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Affiliation(s)
- Cao Wang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Xiang Liu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Zhen Shu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Jia Yin
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Zheng Luo
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Guangxu Zhou
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Bin Liu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
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6
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Lazzarini M, Barbosa MP, Muñoz Fernandez P. Laparoscopic assisted repair of a giant bilateral congenital Morgagni hernia associated with malrotation in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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7
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Gayer G, Shroff GS, Truong MT. Two unusual fat-containing mediastinal entities: Pearls and pitfalls in imaging of Morgagni hernia and fat necrosis. Semin Ultrasound CT MR 2022; 43:267-278. [PMID: 35688537 DOI: 10.1053/j.sult.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review focuses on 2 fat-containing entities in the mediastinum that may raise a diagnostic challenge: Morgagni's hernia and Epipericardial (mediastinal) fat necrosis. Familiarity with the typical imaging findings of these 2 entities is vital for the radiologist to recognize and accurately characterize unusual mediastinal pathological conditions.
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Affiliation(s)
- Gabriela Gayer
- Department of Radiology, Stanford Medical Center, Stanford, CA.
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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8
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Zvizdic Z, Jonuzi A, Pasic IS, Vranic S. Bilateral Morgagni hernia in a two-month-old infant with a history of umbilical cord hernia status repair as a neonate. Asian J Surg 2022; 45:1603-1604. [PMID: 35331589 DOI: 10.1016/j.asjsur.2022.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Irmina Sefic Pasic
- Department of Radiology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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9
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Parlak A, Gurpinar AN. Laparoscopic Repair of Morgagni Hernia in Children. J Laparoendosc Adv Surg Tech A 2022; 32:811-816. [PMID: 35443814 DOI: 10.1089/lap.2021.0797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: This study aims to review laparoscopic repair techniques of Morgagni hernias at a tertiary referral center. Methods: This retrospective study includes pediatric patients who underwent laparoscopic repair of Morgagni hernia between March 2004 and March 2021. The patients' demographics, presenting symptoms, operative approach, and postoperative outcomes were recorded. Results: Fourteen patients underwent laparoscopic repair of Morgagni hernia. The mean age at the time of operation was 24.7 months. Defect closing techniques were intracorporeal knot tying (n: 2), extracorporeal knot tying, and subcutaneous knot placement (n: 10), combination with intracorporeal continuous suturing and several extracorporeal intermittent sutures (n: 2). Different approaches were used during removal of the needle from the insertion point in the extracorporeal knot tying: intracorporeally, using a laparoscopic needle holder (n: 6), with an 18-gauge injector tip (n: 1), and extracorporeally with suture passer forceps (n: 3). In the intracorporeal knot tying technique, the mean operation time was 127 minutes (range 90-180 minutes). In the extracorporeal knot tying technique, the mean operation time was 75 minutes (range 30-180 minutes). The mean operation time in the technique that used suture passer forceps for removing the needle from the same point of insertion was 40 minutes. There was no intraoperative complication. Conclusions: In the laparoscopic repair of Morgagni hernia, full-thickness anterior abdominal wall repair with interrupted sutures that are tied extracorporeally in the subcutaneous tissue by separated minor skin incisions is the easy approach. Using suture passer forceps during removal of the needle facilitates this technique and shortens the operation time.
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Affiliation(s)
- Ayse Parlak
- Department of Pediatric Surgery, Uludag University Medical Faculty, Bursa, Turkey
| | - Arif Nuri Gurpinar
- Department of Pediatric Surgery, Uludag University Medical Faculty, Bursa, Turkey
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10
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Öztorun Cİ, Güney D, Doruk H, Örnek Demir T, Demir S, Ertürk A, Erten EE, Azılı MN, Şenel E. Comparison of Optical Forceps-Assisted Single-Port Laparoscopic PIRS and Open Surgery in Morgagni Hernia Repair. Eur J Pediatr Surg 2022; 32:127-131. [PMID: 35114718 DOI: 10.1055/s-0042-1742663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION This study aimed to compare the results of classical surgery (CS) and optical forceps-assisted single-port laparoscopic percutaneous internal ring suturing (SP-PIRS) repair for the treatment of Morgagni hernia. MATERIALS AND METHODS Patients with Morgagni hernia who were operated on between January 2005 and July 2020 were included in the study. Patients were divided into two groups (CS or SP-PIRS) and compared retrospectively in terms of demographic data, defect size, duration of hospitalization, costs, postoperative complications, and recurrence. RESULTS Thirty-two patients were included in this study. There were no statistically significant differences between the groups in terms of gender, defect size, postoperative complications, and recurrence (p > 0.05). The SP-PIRS group had a shorter operation time (p < 0.01), shorter hospital stay (p = 0.02), and lower cost (p < 0.01) than the CS group. The average follow-up was 24 months, and recurrence was detected in two patients in each group. CONCLUSION SP-PIRS repair is recommended because it is practical to perform and reduces the duration of surgery, hospital stay, and cost. It is superior to other laparoscopic techniques, as there is no need to use additional study forceps, except in extreme cases, and the surgeon can perform the procedure without an assistant to hold the laparoscope.
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Affiliation(s)
- Can İhsan Öztorun
- Department of Pediatric Surgery, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Doğuş Güney
- Department of Pediatric Surgery, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Hayal Doruk
- Department of Pediatric Surgery, Ankara City Hospital, Children's Hospital, Ankara, Turkey
| | - Tuğba Örnek Demir
- Department of Pediatric Surgery, Ankara City Hospital, Children's Hospital, Ankara, Turkey
| | - Sabri Demir
- Department of Pediatric Surgery, Ankara City Hospital, Children's Hospital, Ankara, Turkey
| | - Ahmet Ertürk
- Department of Pediatric Surgery, Ankara City Hospital, Children's Hospital, Ankara, Turkey
| | - Elif Emel Erten
- Department of Pediatric Surgery, Ankara City Hospital, Children's Hospital, Ankara, Turkey
| | - Müjdem Nur Azılı
- Department of Pediatric Surgery, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Emrah Şenel
- Department of Pediatric Surgery, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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11
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Okur MH, Aydogdu B, Azizoglu M, Arslan S, Basuguy E. A novel scarless laparoscopic method for morgagni hernia repair. Niger J Clin Pract 2022; 25:1517-1522. [DOI: 10.4103/njcp.njcp_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Goto Y, Mimori K, Ogata S, Shimizu H, Fukuda Y, Tanaka H. Single-incision laparoscopic full-thickness anterior abdominal wall repair of a Morgagni hernia using a suture-assisting needle in a child: A case report. Asian J Endosc Surg 2021; 14:548-552. [PMID: 32996277 DOI: 10.1111/ases.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/09/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022]
Abstract
Single-incision laparoscopic repair of a congenital Morgagni diaphragmatic hernia using a suture-assisting needle was performed in a 1-year-old boy. Three ports were inserted through a single umbilical incision to repair the 2.5 × 2.3-cm defect. The full-thickness muscle layer of the anterior abdominal wall and the posterior rim of the defect were penetrated with the suture-assisting needle holding a thread, which was then released. The needle tip was pulled back over the muscle layer, shifted laterally, and again passed through the muscle layer and the posterior rim. The thread was then captured by the needle and pulled out through the anterior abdominal wall. Five mattress sutures were placed in this way and tied subcutaneously. The postoperative course was uneventful, and the cosmetic outcome was favorable. A suture-assisting needle is useful for completing full-thickness anterior abdominal wall repair, which is important for preventing the recurrence of a congenital Morgagni diaphragmatic hernia.
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Affiliation(s)
- Yudai Goto
- Department of Pediatric Surgery, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kotaro Mimori
- Department of Pediatric Surgery, Fukushima Medical University Hospital, Fukushima, Japan
| | - Seiya Ogata
- Department of Pediatric Surgery, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hirofumi Shimizu
- Department of Pediatric Surgery, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yutaka Fukuda
- Department of Pediatrics, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Hideaki Tanaka
- Department of Pediatric Surgery, Fukushima Medical University Hospital, Fukushima, Japan
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13
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Sher M, Gopalakaje S, Justo R, Choo K, Kapur N. Rare case of Morgagni hernia presenting with cyanotic spells in a neonate. J Paediatr Child Health 2021; 57:289-292. [PMID: 32173927 DOI: 10.1111/jpc.14859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/26/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mustafa Sher
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Saikiran Gopalakaje
- Respiratory Division, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Robert Justo
- Respiratory Division, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kelvin Choo
- Surgery Division, Mater Children's Private Hospital, Brisbane, Queensland, Australia
| | - Nitin Kapur
- Respiratory Division, Queensland Children's Hospital, Brisbane, Queensland, Australia
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14
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Perforated Appendicitis and Bowel Incarceration within Morgagni Hernia: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57020089. [PMID: 33494223 PMCID: PMC7909783 DOI: 10.3390/medicina57020089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
Morgagni hernia (MH) is a result of abdominal organ protrusion through the congenital defect in the anterior retrosternal aspect of the diaphragm. The colon and omentum are the most commonly involved organs, followed by the small intestine, stomach and liver. Symptoms of MH may be absent, although the majority of patients will experience mild dyspnea or abdominal discomfort. We present a case of MH complicated with intrathoracic acute perforated appendicitis and intestinal obstruction.
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15
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Lundy PA, Partington MD, Tuchek CA, Garcia DM. Intrathoracic migration of ventriculo-peritoneal shunt via Morgagni hernia. Childs Nerv Syst 2021; 37:345-347. [PMID: 33063133 DOI: 10.1007/s00381-020-04926-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
We present the case of a 5-month-old patient presenting with pleural migration of ventriculo-peritoneal shunt catheter who returned 2 months later with respiratory distress. Ultimately, the diagnosis of a Morgagni hernia was made. This diagnosis, though rare, should be entertained in certain clinical settings.
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Affiliation(s)
- Paige A Lundy
- Department of Neurological Surgery, University of Kansas, Kansas City, KS, USA. .,The University of Kansas Health System, 3901 Rainbow Blvd Mail Stop 3021, Kansas City, KS, 66160, USA.
| | - Michael D Partington
- Department of Neurological Surgery, University of Kansas, Kansas City, KS, USA.,Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri at Kansas City, Kansas City, MO, USA
| | - Chad A Tuchek
- Department of Neurological Surgery, University of Kansas, Kansas City, KS, USA
| | - David M Garcia
- Department of Neurological Surgery, University of Kansas, Kansas City, KS, USA.,Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri at Kansas City, Kansas City, MO, USA
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16
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Anadolulu Aİ, Gerçel G, Kocaman OH. Laparoscopic repair of Morgagni hernia in children. Ann Med Surg (Lond) 2020; 56:7-10. [PMID: 32551107 PMCID: PMC7292882 DOI: 10.1016/j.amsu.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/15/2022] Open
Abstract
Aim We aimed to present our laparoscopic treatment experience in Morgagni hernia repair. Methods The patients who underwent laparoscopic surgery with diagnosis of Morgagni hernia between 2016 and 2019 were evaluated retrospectively. Results Their mean age at diagnosis was 4,1 ± 2,6 years (1 year-13 years). All patients were male. The presenting complaints were respiratory tract infection in 3 patients and vomiting in 3. Two patients were diagnosed incidentally. Associated Down's Syndrome was detected in 3 (38%) cases. The defect was left-sided in 7 (87.5%) patients and bilateral in 1 (12,5%). Omentum was herniated in 2 patients, colon and omentum were in 6 and colon, omentum and stomach were in one. All patients underwent primary repair extracorporeally by removing sutures from single incision, without removal of the hernia sac. There were no complications or recurrence in the mean 19,2 ± 15,8 months (6-42 months) follow-up period. Conclusions Minimal invasive repair of Morgagni hernia is efficient and safe. It should be the first choice because of fast recovery and better cosmetic results. In this series, it was seen that leaving the hernia sac had no effect on early and late complications. Leaving the hernia sac may prevent potential complications due to unnecessary dissection.
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Affiliation(s)
- Ali İhsan Anadolulu
- Mehmet Akif İnan Training and Research Hospital Clinic of Pediatric Surgery, Şanlıurfa, Turkey
| | - Gonca Gerçel
- Şanlıurfa Training and Research Hospital Clinic of Pediatric Surgery, Şanlıurfa, Turkey
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17
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Bawazir OA, Mahomed A, Fayyad A, Bagaryn E, Bawazir A, Mandora R. Laparoscopic-assisted repair of Morgagni hernia in children. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00022-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Morgagni hernia (MH) is a rare diaphragmatic hernia with nonspecific symptoms and variable presentation. MH is managed surgically via laparotomy or a thoracotomy. Recently, laparoscopy was described for the repair of MH. The objective of this study is to report our institutional experience in laparoscopic repair of MH in infants and children.
Results
Twenty-five patients with MH were included; 17 of them were males (68%). Their median age at the time of diagnosis was 18 months. Sixteen patients (64%) presented with a recurrent chest infection. MH was on the right side in 8 patients, left side in 2, and central in 12, and 3 patients had bilateral hernias. Eleven patients (44%) had congenital heart disease, 10 (40%) had Down’s syndrome, and 2 (4%) had malrotation of the bowel. The median size of the hernia defect was 3 × 3.5 cm2, and the most common content was the colon (n = 19). One patient with Down’s syndrome developed recurrence and underwent open repair. The median operative time was 95 min. The postoperative recovery was uneventful, and the average postoperative stay was 3 days. The median follow-up was 4.5 years, and there was no reported mortality.
Conclusions
Morgagni hernia is commonly associated with other congenital anomalies. Laparoscopic repair of Morgagni hernia in children is feasible with excellent postoperative outcomes.
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18
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Oppelt PU, Askevold I, Bender F, Liese J, Padberg W, Hecker A, Reichert M. Morgagni-Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience. Hernia 2020; 25:479-489. [PMID: 32112200 PMCID: PMC8055631 DOI: 10.1007/s10029-020-02147-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/06/2020] [Indexed: 01/13/2023]
Abstract
Purpose Morgagni−Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial treatment modality is low. Nevertheless, with increasing experience in minimally-invasive surgery, the literature proves the laparoscopic approach as being safely feasible. However, knowledge on the disease as well as treatment options are based on single surgeon’s experiences and small case series in the literature. Methods Retrospective single-center analysis on adult patients (≥ 18 years) with MLH from 01/2003 to 06/2019 regarding symptoms, hernia sac contents, surgical technique and perioperative outcome. Results 4.0% of diaphragmatic hernia repair procedures were performed for MLH (n = 11 patients). 27.3% of these patients were asymptomatic. Dyspnea or gastrointestinal symptoms were frequently observed (both in 45.5% of the patients). Colon transversum (63.6%), omentum majus (45.5%) and/or stomach (27.3%) were the most common hernia sac contents. Correct diagnosis was achieved preoperatively in 10/11 patients by cross-sectional imaging. All procedures were performed by trans-abdominal surgery (laparotomy in four and laparoscopy in seven patients). All hernias were reinforced by mesh after primary closure. No differences were observed in the perioperative outcome between patients who underwent hernia repair by laparotomy versus laparoscopy. Pleural complications requiring drainage were the most common postoperative complications. Conclusion MLH repair seems to be safely feasible by laparoscopic surgery. The benefit of mesh augmentation in MLH repair is not clear yet. In contrast to the current literature, all patients in this study received mesh augmentation after primary closure of the hernia. This should be evaluated in larger patient cohorts with long-term follow-up.
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Affiliation(s)
- P U Oppelt
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - I Askevold
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - F Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - J Liese
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - A Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - M Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany.
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Lim L, Gilyard SM, Sydorak RM, Lau ST, Yoo EY, Shaul DB. Minimally Invasive Repair of Pediatric Morgagni Hernias Using Transfascial Sutures with Extracorporeal Knot Tying. Perm J 2019; 23:18.208. [PMID: 31926567 DOI: 10.7812/tpp/18.208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Morgagni hernias are rare, with a reported incidence of 2% to 5% of congenital diaphragmatic hernias. OBJECTIVES To review a laparoscopic technique to repair Morgagni hernias in pediatric patients. METHODS Retrospective chart review of pediatric patients who underwent minimally invasive repair of a Morgagni hernia from November 2009 to September 2017 within a defined population. RESULTS During an 8-year period, 15 patients with Morgagni hernias were identified. Four patients with Morgagni hernias were excluded because they had open repairs. Eleven Morgagni hernias were repaired through a completely minimally invasive approach. Three repairs were completed using a soft-tissue patch (Gore-Tex patch, W L Gore & Associates Inc, Flagstaff, AZ). All minimally invasive repairs were completed with transfascial sutures using an endoscopic suturing device (Endo Close, Covidien/Medtronic, Fridley, MN) and 2-0 nonabsorbable synthetic sutures with extracorporeal knot tying. Median follow-up was 40 months (range = 2.6 months to 7.3 years). No patients had postoperative pectus excavatum defects. There were no recurrences. CONCLUSION Morgagni hernias are amenable to minimally invasive repair with this simple technique. With large defects, synthetic patches should be used. Recurrences are rare, and morbidity is low.
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Affiliation(s)
- Lian Lim
- Department of General Surgery, Los Angeles Medical Center, CA
| | - Sarah M Gilyard
- Department of General Surgery, Los Angeles Medical Center, CA
| | - Roman M Sydorak
- Department of Pediatric Surgery, Los Angeles Medical Center, CA
| | - Stanley T Lau
- Department of Pediatric Surgery, Los Angeles Medical Center, CA
| | - Edward Y Yoo
- Department of Pediatric Surgery, Los Angeles Medical Center, CA
| | - Donald B Shaul
- Department of Pediatric Surgery, Los Angeles Medical Center, CA
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20
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Young MC, Saddoughi SA, Aho JM, Harmsen WS, Allen MS, Blackmon SH, Cassivi SD, Nichols FC, Shen KR, Wigle DA. Comparison of Laparoscopic Versus Open Surgical Management of Morgagni Hernia. Ann Thorac Surg 2018; 107:257-261. [PMID: 30296422 DOI: 10.1016/j.athoracsur.2018.08.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Morgagni hernias are rare congenital diaphragmatic hernias that often do not become clinically significant until adulthood. The purpose of this study was to characterize the preoperative findings and describe surgical outcomes of Morgagni hernia repair based on operative approach. METHODS Charts of patients who underwent repair of a Morgagni hernia were retrospectively reviewed from 1987 to 2015. Medical records were reviewed for demographics, symptoms, comorbidities, surgical approach, hospital course, complications, and preoperative imaging. RESULTS Forty-three cases were identified, 23 male and 20 female. Median age was 50.4 years, and median body mass index was 33.1 kg/m2. Most common presenting symptoms were respiratory (35.7%) and gastrointestinal (28.6%). Although 83.3% of cases were newly diagnosed, none required emergent repair. Preoperative imaging demonstrated an average hernia size of 8.2 cm. Surgical approaches included laparotomy (62.8%), laparoscopic (23.3%), and thoracotomy (14%). Primary hernia repair was most common (72%). Comparing laparotomy, thoracotomy, and laparoscopic approaches, mesh repair was more common with laparoscopy (p = 0.005), operative time was shortest with laparotomy (p = 0.029), and hospital length of stay was shortest with laparoscopy (p = 0.024). The most common complication was incisional/port site hernia, with no statistical significance between surgical approaches. There was one Morgagni hernia recurrence. CONCLUSIONS Morgagni hernias often present with respiratory and gastrointestinal symptoms and require repair. All cases in our series were repaired electively. Regardless of approach recurrence rate was low (2.3%) and complication rate was similar between laparoscopic, laparotomy, and thoracotomy. Given the shorter length of stay with similar recurrence rates, a laparoscopic approach is a viable option for repair of Morgagni hernia.
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Affiliation(s)
- Michael C Young
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sahar A Saddoughi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Johnathon M Aho
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - William S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Mark S Allen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Shanda H Blackmon
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stephen D Cassivi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Francis C Nichols
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - K Robert Shen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dennis A Wigle
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
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21
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Tan YW, Banerjee D, Cross KM, De Coppi P, Blackburn SC, Rees CM, Giuliani S, Curry JI, Eaton S. Morgagni hernia repair in children over two decades: Institutional experience, systematic review, and meta-analysis of 296 patients. J Pediatr Surg 2018; 53:1883-1889. [PMID: 29776739 DOI: 10.1016/j.jpedsurg.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND/PURPOSE Morgagni diaphragmatic hernia (MH) is rare. We report our experience based on routine patch use in MH repair to curb recurrence. A systematic review and meta-analysis were performed to study the recurrence and complications associated with minimally invasive surgery and the use of patch. METHODS We retrospectively reviewed all cases of MH who underwent first-time repair in 2012-2017 in our institution to determine recurrence and complication rate. A MEDLINE search related to minimally invasive surgery (MIS) and patch repair of MH was conducted for systematic review. Eligible articles published from 1997-2017 with follow-up data available were included. Primary outcomes measured were recurrence and complication. Meta-analysis to compare open versus MIS and primary versus patch repair in the MIS group were performed in comparative cohorts. Continuous data were presented as median (range), and statistical significance was P<0.05. RESULTS In our institution, 12 consecutive patients aged 17-month-old (22 days-7 years), underwent laparoscopic patch repair of MH, with one conversion to laparotomy. No recurrence or significant complication occurred over a follow-up period of 8 months (1-48 months). Thirty-six articles were included from literature review and were combined with the current series. All were retrospective case reports or series, of which 6 were comparative cohorts with both MIS and open repairs. A total of 296 patients from 37 series were ultimately used for analysis: 80 had open repair (4 patch) and 216 had MIS repair (32 patch), with a patch rate of 12%. There were 13 recurrences (4%): no difference between open and MIS repairs (4/80 vs 9/216, p=0.75); recurrence rate following primary repair was 13/260 (5%), but no recurrence occurred with 36 patch repairs. Meta-analysis showed no difference in recurrence between open and MIS repair (p=0.83), whereas patch repair was associated with 14% less recurrence compared with primary repair, although it did not reach statistical significance (p=0.12). There were 13 complications (5%): no difference between open and MIS repairs (5/80 vs 8/216, p=0.35). One small bowel obstruction occurred in a patient who had laparoscopic patch repair. CONCLUSION In MH, recurrence and complication rates are comparable between MIS and open repairs. Use of patch appeared to confer additional benefit in reducing recurrence. TYPE OF STUDY Systematic review LEVEL OF EVIDENCE: 3A.
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Affiliation(s)
- Yew-Wei Tan
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Debasish Banerjee
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Kate M Cross
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK; Stem Cells & Regenerative Medicine, DBC, Great Ormond Street Institute of Child Health, University College London, UK.
| | | | - Simon C Blackburn
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Clare M Rees
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Stefano Giuliani
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Joe I Curry
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Simon Eaton
- Stem Cells & Regenerative Medicine, DBC, Great Ormond Street Institute of Child Health, University College London, UK
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22
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Saima T, Sato M, Miyake Y, Matsui H. Unknown mass on chest radiography: Morgagni hernia identified on ultrasonography. Pediatr Int 2018; 60:904-905. [PMID: 30255978 DOI: 10.1111/ped.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Takahiro Saima
- Department of Pediatric Intensive Care, Nagano Children's Hospital, Azumino City, Nagano, Japan
| | - Masanori Sato
- Department of Pediatric Intensive Care, Nagano Children's Hospital, Azumino City, Nagano, Japan
| | - Yuichiro Miyake
- Department of Pediatric Surgery, Nagano Children's Hospital, Azumino City, Nagano, Japan
| | - Hikoro Matsui
- Department of Pediatric Intensive Care, Nagano Children's Hospital, Azumino City, Nagano, Japan
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23
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Lauriti G, Zani-Ruttenstock E, Catania VD, Antounians L, Lelli Chiesa P, Pierro A, Zani A. Open Versus Laparoscopic Approach for Morgagni's Hernia in Infants and Children: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:888-893. [PMID: 29775548 DOI: 10.1089/lap.2018.0103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The laparoscopic repair of Morgagni's hernia (MH) has been reported to be safe and feasible. However, it is still unclear whether laparoscopy is superior to open surgery in repairing MH. MATERIALS AND METHODS Using a defined search strategy, three investigators independently identified all comparative studies reporting data on open and laparoscopic MH repair in patients <18 years of age. Case reports and opinion articles were excluded. Meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3. Data are expressed as mean ± SD. RESULTS Systematic review - Of 774 titles/abstracts screened, 51 full-text articles were analyzed. Three studies were included (92 patients), with 53 (58%) open approaches and 39 (42%) laparoscopy. Meta-analysis - The length of surgery was shorter in laparoscopy (50.5 ± 17.0 min) than in open procedure (90.0 ± 15.0 min; P < .00001). Laparoscopy shortened the length of hospital stay (2.1 ± 1.4 days) versus open surgery (4.5 ± 2.1 days; P < .00001). There was no difference with regards to complications (laparoscopy: 8.8% ± 5.5%, open: 9.4% ± 1.6%; P = .087) and recurrences (laparoscopy: 2.9% ± 5.0%, open: 5.7% ± 1.8%; P = .84). DISCUSSION Comparative studies indicate that laparoscopic MH repair can be performed in infants and children. Laparoscopy is associated with shortened length of surgery and hospital stay in comparison to open procedure. Prospective randomized studies would be needed to confirm present data.
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Affiliation(s)
- Giuseppe Lauriti
- 1 Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto , Toronto, Canada .,2 Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, and "G. d'Annunzio" University , Pescara, Italy
| | - Elke Zani-Ruttenstock
- 1 Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto , Toronto, Canada
| | - Vincenzo D Catania
- 1 Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto , Toronto, Canada
| | - Lina Antounians
- 1 Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto , Toronto, Canada
| | - Pierluigi Lelli Chiesa
- 2 Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, and "G. d'Annunzio" University , Pescara, Italy
| | - Agostino Pierro
- 1 Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto , Toronto, Canada
| | - Augusto Zani
- 1 Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto , Toronto, Canada
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24
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Escarcega P, Riquelme MA, Lopez S, González AD, Leon VY, Garcia LR, Cabrera H, Solano H, Garcia C, Espinosa JR, Geistkemper CL, Elizondo RA. Multi-Institution Case Series of Pediatric Patients with Laparoscopic Repair of Morgagni Hernia. J Laparoendosc Adv Surg Tech A 2018; 28:1019-1022. [PMID: 29620946 DOI: 10.1089/lap.2017.0621] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Morgagni Larray hernia (MLH) is a very rare disease, which accounts for less than 5% of all congenital diaphragmatic hernias. Laparoscopic repair has been widely used and accepted as a treatment option for patients with this disease. The purpose of our study is to analyze the outcomes of patients with MLH who underwent laparoscopic repair, and to evaluate their postoperative course for outcome, morbidity, and mortality. MATERIALS AND METHODS A retrospective chart review was performed of patients who were diagnosed with MLH and treated laparoscopically by 10 board-certified pediatric surgeons. RESULTS Fourteen patients were included in the study. One patient died 1 month postoperatively due to respiratory complications unrelated to the surgery. Thirteen patients were followed for a median of 1.75 years (interquartile 0.3-6.95). There was a single recurrence, which resulted in a partial resection of the hernia sac and repaired without a mesh. We had a success rate of 92.86%. CONCLUSION MLH is a rare congenital diaphragmatic hernia that is usually diagnosed incidentally. Laparoscopic repair has high success rates and is a viable option for patients with this pathology.
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Affiliation(s)
- Pastor Escarcega
- 1 Department of Pediatric Surgery, Centro de Alta Especialidad Dr. Rafael Lucio , Veracruz, Mexico
| | - Mario A Riquelme
- 2 Department of Pediatric Surgery, Christus Muguerza/UdeM , Monterrey, Mexico
| | - Secundino Lopez
- 3 Department of Pediatric Surgery, Hospital del Niño y el Adolescente Morelense , Morelos, Mexico
| | - Alma D González
- 3 Department of Pediatric Surgery, Hospital del Niño y el Adolescente Morelense , Morelos, Mexico
| | - Victor Y Leon
- 4 Department of Pediatric Surgery, HGR IMSS , Baja California, Mexico
| | - Luis R Garcia
- 5 Department of Pediatric Surgery, Hospital Infantil de Especialidades de Chihuahua , Chihuahua, Mexico
| | - Hugo Cabrera
- 6 Department of Pediatric Surgery, Hospital Angeles , Puebla, Mexico
| | - Heriberto Solano
- 7 Department of Pediatric Surgery, Hospital Hispano Americano , Baja California, Mexico
| | - Carlos Garcia
- 8 Department of Pediatric Surgery, Hospital Infantil Privado Ciudad de Mexico, Mexico
| | - Jorge R Espinosa
- 9 Department of Pediatric Surgery, Hospital de Especialidades del Niño y la Mujer , Averetaro, Mexico
| | | | - Rodolfo A Elizondo
- 10 Department of Pediatric Urology, Texas Children's Hospital , Houston, Texas
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25
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Chetambath R, Parengal J, Aslam M, Shivashankaran S. A rare clinical case presenting as right lower zone shadow. Lung India 2018; 35:173-175. [PMID: 29487258 PMCID: PMC5846272 DOI: 10.4103/lungindia.lungindia_99_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Congenital Morgagni’s hernia in infants and children. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000516210.28462.2d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Golden J, Barry WE, Jang G, Nguyen N, Bliss D. Pediatric Morgagni diaphragmatic hernia: a descriptive study. Pediatr Surg Int 2017; 33:771-775. [PMID: 28289880 DOI: 10.1007/s00383-017-4078-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The Morgagni hernia (MH) accounts for 3-4% of congenital diaphragmatic hernias. There is a paucity of data regarding this rare defect. The purpose of this study is to describe the characteristics of children with MH, surgical approaches for repair, and patient outcomes. METHODS Pediatric patients (ages 0-18) with a MH from 2002 to 2014 at a single, freestanding pediatric hospital were retrospectively reviewed. Patient presentation, demographics, operative methods and findings, and outcomes were evaluated. RESULTS Twenty-six infants and children with a congenital MH were treated. There were 20 males (77%) and six females (23%) with a median age at diagnosis of 14.75 months (range 1 week to 13 years). Half were symptomatic. Sixteen hernias were repaired laparoscopically, nine by an open approach, and one laparoscopic converted to open. Colon was the most commonly herniated organ (N = 14). Hernia sacs were found in 22 patients of which, 20 were resected. Two patients underwent treatment with ECLS. There was one mortality in a patient who underwent repair on ECLS in the setting of an omphalocele and SVC obstruction. There were no recurrences in our sample. CONCLUSION In this series, congenital MH appears to have a male predominance, frequently presents with pulmonary symptoms, and has excellent outcomes regardless of operative approach.
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Affiliation(s)
- Jamie Golden
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Wesley E Barry
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Gene Jang
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Nam Nguyen
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - David Bliss
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA.
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28
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Khan HA, Samad A, Khan OA, Chagan FK, Khan JK, Fatimi SH. Hernia of Morgagni Presenting as Constipation in a 65-Year-Old Male. Cureus 2017; 9:e1278. [PMID: 28656126 PMCID: PMC5484600 DOI: 10.7759/cureus.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hernia of Morgagni is congenital defects in the diaphragm. They are mostly asymptomatic and present with vague symptoms when they do so. A high index of suspicion is required for timely diagnose of this condition. Here we present the case of a 65-year-old male patient presented to our institute with constipation for the past six months. Chest radiology raised the suspicion of a hernia which was further confirmed by contrast studies. Laparotomy was done and the hernia sac identified, colon and greater omentum reduced and defect repaired. He was discharged in stable condition and was doing well on follow-up.
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Affiliation(s)
| | | | - Omar A Khan
- Medical College, Jinnah Sindh Medical University (SMC)
| | | | | | - Saulat H Fatimi
- Department of Cardiothoracic Surgery, The Aga Khan University
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29
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Shimada M, Hoashi T, Tazuke Y, Kagisaki K, Ichikawa H. Simultaneous repair of Morgagni hernia and ventricular septal defect. Pediatr Int 2017; 59:367-368. [PMID: 28317299 DOI: 10.1111/ped.13213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 11/29/2016] [Accepted: 12/02/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Masatoshi Shimada
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koji Kagisaki
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Kim DK, Moon HS, Jung HY, Sung JK, Gang SH, Kim MH. An Incidental Discovery of Morgagni Hernia in an Elderly Patient Presented with Chronic Dyspepsia. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 69:68-73. [DOI: 10.4166/kjg.2017.69.1.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Duk Ki Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University of Medicine, Daejeon, Korea
| | - Hee Seok Moon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University of Medicine, Daejeon, Korea
| | - Hyeon Yong Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University of Medicine, Daejeon, Korea
| | - Jae Kyu Sung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University of Medicine, Daejeon, Korea
| | - Sun Hyeong Gang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University of Medicine, Daejeon, Korea
| | - Myeong Hee Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University of Medicine, Daejeon, Korea
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31
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Yilmaz E, Afsarlar CE, Erdogan D, Ozguner IF. Outpatient single-port laparoscopic percutaneous Morgagni hernia repair assisted by an optical forceps. MINIM INVASIV THER 2016; 26:182-187. [PMID: 27869520 DOI: 10.1080/13645706.2016.1263213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Morgagni hernia is a relatively rare form of diaphragmatic hernia in the pediatric age group and it is conventionally treated with open surgical repair. Minimal access surgery is currently being adapted for many procedures in children. However, to date just a few techniques have been described relevant to minimal access surgical repair of Morgagni hernia in children. Herein, we report two cases of Morgagni hernia repaired by a new single-port laparoscopic technique assisted by an optical forceps. Two infants, a one-year-old boy and an eight-month-old girl, were operated with this technique in just 26 and 35 min and were discharged with oral analgesic prescription by postoperative hour 5 and 8, respectively. In the English-language literature, these cases are the first reports of laparoscopic Morgagni hernia repair that were performed as an outpatient procedure. Also, the technique introduced can be easily applied by a single surgeon without an assistant to operate the laparoscope.
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Affiliation(s)
- Engin Yilmaz
- a Department of Pediatric Surgery , Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Cagatay Evrim Afsarlar
- a Department of Pediatric Surgery , Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Derya Erdogan
- a Department of Pediatric Surgery , Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Ismet Faruk Ozguner
- a Department of Pediatric Surgery , Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
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32
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A missed complicated Morgagni–Larrey’s hernia. ANNALS OF PEDIATRIC SURGERY 2016. [DOI: 10.1097/01.xps.0000491017.20793.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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33
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Phillis M, Garcia AV, Jelin EB. A Morgagni hernia with an absent ductus venosus: An unusual case causing unusual consequences. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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34
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Bilateral Morgagni Hernia: A Unique Presentation of a Rare Pathology. Case Rep Radiol 2016; 2016:7505329. [PMID: 27403367 PMCID: PMC4923526 DOI: 10.1155/2016/7505329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/29/2016] [Indexed: 11/20/2022] Open
Abstract
Morgagni hernia is an unusual congenital herniation of abdominal content through the triangular parasternal gaps of the anterior diaphragm. They are commonly asymptomatic and right-sided. We present a case of a bilateral Morgagni hernia resulting in delayed growth in a 10-month-old boy. The presentation was unique due to its bilateral nature and its symptomatic compression of the mediastinum. Diagnosis was made by 3D reconstructed CT angiogram. The patient underwent medical optimization until he was safely able to tolerate laparoscopic surgical repair of his hernia. Upon laparoscopy, the CT findings were confirmed and the hernia was repaired.
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Kozanhan B, Başaran B, Aygın F, Akkoyun İ, Özmen S. Anaesthetic Management of Laparoscopic Morgagni Hernia Repair in a Patient with Coexisting Down Syndrome, Patent Foramen Ovale and Pectus Carinatum. Turk J Anaesthesiol Reanim 2016; 44:44-6. [PMID: 27366555 DOI: 10.5152/tjar.2016.13007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/21/2014] [Indexed: 11/22/2022] Open
Abstract
Laparoscopic repair has several advantages with a minimally invasive surgical option for children with Morgagni hernias; however, a number of physiological sequelae results from pneumoperitoneum and insufflation. These physiological changes may be more significant in patients with a congenital heart disease. Perioperative detailed evaluation, meticulous monitorization and cooperation with a surgical team are important in cases with patent foramen ovale for the possible risk of the paradoxical gas embolism. We present the anaesthetic management of a patient with patent foramen ovale, Down syndrome and pectus carinatus who successfully underwent laparoscopic Morgagni hernia repair. Under a well-managed anaesthesia that prevented complications because of pneumoperitoneum, laparoscopic surgery would be safe enough for patients with Morgagni hernia having an associated congenital heart disease.
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Affiliation(s)
- Betül Kozanhan
- Clinic of Anaesthesiology and Reanimation, Konya Training and Research Hospital, Konya, Turkey
| | - Betül Başaran
- Clinic of Anaesthesiology and Reanimation, Konya Training and Research Hospital, Konya, Turkey
| | - Feride Aygın
- Clinic of Anaesthesiology and Reanimation, Konya Training and Research Hospital, Konya, Turkey
| | - İbrahim Akkoyun
- Clinic of Pediatric Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Sadık Özmen
- Clinic of Anaesthesiology and Reanimation, Konya Training and Research Hospital, Konya, Turkey
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36
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Slepov O, Kurinnyi S, Ponomarenko O, Migur M. Congenital retrosternal hernias of Morgagni: Manifestation and treatment in children. Afr J Paediatr Surg 2016; 13:57-62. [PMID: 27251653 PMCID: PMC4955447 DOI: 10.4103/0189-6725.182557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Due to scarcity of congenital diaphragmatic hearnias of Morgagni (CDHM), non-specific clinical presentation in the pediatric age group, we aimed to investigate the incidence, clinical manifestations, anatomical characteristics, and develop diagnostic algorithm and treatment of CDHM in children. MATERIALS AND METHODS The patients' records of children with CDHM treated in our hospital during past 20 years were retrospectively reviewed for the age at diagnosis, gender, clinical findings, anatomical features, operative details and outcome. RESULTS Since 1995 to 2014 we observed 6 (3 boys, 3 girls) patients with CDHM, that comprise 3.2% of all congenital diaphragmatic hernia cases (n = 185). Age at diagnosis varied from 3 mo. to 10y.o. Failure to thrive was main symptom in 4 patients, followed by recurrent respiratory infections (n = 3), dyspnea (n = 3), and gastrointestinal manifestations: constipation (n = 2), abdominal pain (n = 1). Work-up consisted of plain X-ray for all (n = 6), upper GI (n = 3), barium enema (n = 2), sonography (n = 6) and CT (n = 2). Abdominal approach used in 5 patients, and thoracotomy in one. Herniated contents were: liver lobes (n = 4), transverse colon (n = 3) and greater omentum (n = 1). 5 had right-sided lesion, 1- left-sided. Defect repaired using local tissues. Post-operative course was uneventful; all patients appeared well during follow-up. CONCLUSION CDHM is very uncommon anomaly, very occasionally diagnosed at the early age. Failure to thrive and recurrent respiratory infections are most frequent clinical manifestations. In suspected CDHM we advocate the following work-up: plain chest and abdominal X-ray, contrast study (upper GI series or barium enema), ultrasonographic screen and CT scan. Surgical repair via abdominal approach, using local tissues and hernia sac removal is preferred.
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Affiliation(s)
- Oleksii Slepov
- Department of Pediatric Surgery, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Sergii Kurinnyi
- Department of Pediatric Surgery, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Oleksii Ponomarenko
- Department of Pediatric Surgery, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Mikhailo Migur
- Department of Pediatric Surgery, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
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Grizelj R, Bojanić K, Vuković J, Weingarten TN, Sprung J. Waxing and Waning Congenital Diaphragmatic Hernia of Morgagni: A Diagnostic Conundrum. Pediatr Neonatol 2016; 57:160-1. [PMID: 26611235 DOI: 10.1016/j.pedneo.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/03/2015] [Accepted: 06/12/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Ruža Grizelj
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Katarina Bojanić
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | - Jurica Vuković
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia
| | | | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
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38
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Garofalo S, Guanà R, Schleef J. Thoracic Intestinal Sounds in an Infant with Congenital Bilateral Morgagni Hernia. J Pediatr 2016; 169:325-325.e1. [PMID: 26654136 DOI: 10.1016/j.jpeds.2015.10.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Salvatore Garofalo
- Department of Pediatric General Surgery, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Riccardo Guanà
- Department of Pediatric General Surgery, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Jürgen Schleef
- Department of Pediatric General Surgery, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza, Turin, Italy
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39
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Jaiswal SS, Pujahari AK, Mehra R, Singh G. Congenital Morgagni hernia. Med J Armed Forces India 2015; 71:396-9. [PMID: 26663973 DOI: 10.1016/j.mjafi.2014.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 12/05/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- S S Jaiswal
- Associate Professor, Department of Surgery, Armed Forces Medical College, Pune 411040, India
| | - A K Pujahari
- Ex-Professor & Head, Department of Surgery, Armed Forces Medical College, Pune 411040, India
| | - Rohit Mehra
- Assistant Professor, Department of Surgery, Armed Forces Medical College, Pune 411040, India
| | - Gagandeep Singh
- Assistant Professor, Department of Surgery, Armed Forces Medical College, Pune 411040, India
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40
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Zouari M, Jallouli M, Bendhaou M, Zitouni H, Mhiri R. Percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia: Review of three cases. Arch Pediatr 2015; 22:1272-5. [PMID: 26552622 DOI: 10.1016/j.arcped.2015.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/15/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022]
Abstract
Morgagni hernias are uncommon, accounting for only 1-2% of all congenital diaphragmatic hernia. Minimally invasive surgery is today the gold standard treatment. We present a technique using percutaneous suturing and single-site umbilical laparoscopic repair of Morgagni hernia in three children. Recovery was uneventful in all three patients. There was no recurrence and the chest radiograph remained normal during the postoperative follow-up. The percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia is an easy and effective alternative to standard laparoscopic repair.
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Affiliation(s)
- M Zouari
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia; School of medicine, University of Sfax, Sfax, Tunisia.
| | - M Jallouli
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia; School of medicine, University of Sfax, Sfax, Tunisia
| | - M Bendhaou
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia; School of medicine, University of Sfax, Sfax, Tunisia
| | - H Zitouni
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia; School of medicine, University of Sfax, Sfax, Tunisia
| | - R Mhiri
- Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia; School of medicine, University of Sfax, Sfax, Tunisia
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41
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Zhu XQ, Guan WX. Laparoscopic assisted extraperitoneal hernia sac high ligation vs traditional surgery for inguinal hernia in preschool children. Shijie Huaren Xiaohua Zazhi 2015; 23:2168-2173. [DOI: 10.11569/wcjd.v23.i13.2168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the clinical effects of laparoscopic assisted extraperitoneal hernia sac high ligation with traditional surgery in the management of inguinal hernia in preschool children.
METHODS: Preschool children with inguinal hernia treated at Suqian People's Hospital from March 2013 to January 2015 were divided into two groups to receive either laparoscopic assisted extraperitoneal hernia sac high ligation (observation group, n = 53) or traditional surgery (control group, n = 49). Operative time, hospital stay, and postoperative complications were compared for the two groups.
RESULTS: All surgical procedures were successful in the two groups. The mean operation time and hospital stay were significantly better in the observation group than in the control group (15.35 min ± 2.11 min vs 20.45 min ± 3.74, 2.0 d vs 3.5 d, P < 0. 05). The postoperative follow-up duration was 6 mo, during which no postoperative recurrence was observed in the observation group. One case of contralateral hernia developed in patients with unilateral inguinal hernia in the observation group. In the control group, 7 cases of contralateral hernia appeared.
CONCLUSION: Laparoscopic assisted extraperitoneal hernia sac high ligation treatment of inguinal hernia in preschool children is feasible and convenient, with shorter hospital stay and fewer postoperative complications.
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42
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Prenatal diagnosis and array comparative genomic hybridization characterization of trisomy 21 in a fetus associated with right congenital diaphragmatic hernia and a review of the literature of chromosomal abnormalities associated with congenital diaphragmatic hernia. Taiwan J Obstet Gynecol 2015; 54:66-70. [PMID: 25675923 DOI: 10.1016/j.tjog.2014.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Rapid genome-wide aneuploidy diagnosis using uncultured amniocytes and array comparative genomic hybridization (aCGH) is useful in pregnancy with abnormal ultrasound findings. The purpose of this report is to report a case of right congenital diaphragmatic hernia (CDH) associated with trisomy 21 diagnosed prenatally by aCGH and to review the literature of chromosomal abnormalities associated with CDH. CASE REPORT A 29-year-old woman was referred for genetic counseling at 25 weeks of gestation because of fetal CDH. The pregnancy was uneventful until 25 weeks of gestation when level II ultrasound detected isolated right CDH. Ultrasound showed that the liver and gallbladder were located in the right hemithorax, and there was levocardia. Fetal magnetic resonance imaging confirmed the diagnosis of right CDH with the gallbladder and part of the liver appearing in the right hemithorax and the heart shifting to the left hemithorax. Amniocentesis was immediately performed. About 10 mL of amniotic fluid was sent for aCGH analysis by use of the DNA extracted from uncultured amniocytes, and 20 mL of amniotic fluid was sent for conventional cytogenetic analysis. aCGH analysis revealed the result of arr 21p11.2q22.3 (9,962,872-48,129,895) × 3, consistent with the diagnosis of trisomy 21. Conventional cytogenetics revealed a karyotype of 47,XY,+21. Postnatally, polymorphic DNA marker analysis using DNAs extracted from the placenta and parental bloods showed a heterozygous extra chromosome 21 of maternal origin consistent with the result of maternal meiosis I nondisjunction. CONCLUSION Prenatal diagnosis of right CDH should raise a suspicion of chromosomal abnormalities especially trisomy 21 and the association of Morgagni hernia.
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