[Indications, techniques and results of laparoscopic surgery for diaphragmatic diseases]

Concomitant trans-sternal repair of Morgagni hernia and ventricular septal defect in a patient with Down syndrome: A case report

INTRODUCTION

Morgagni hernia is a rare type of hernia occurring secondary to potential anterior-medial defects in the diaphragm. The association of the defect with congenital cardiac pathologies and Down syndrome are well known. The defect is repaired usually by trans-abdominal or transthoracic approaches. Trans-sternal repair of the hernia is preferred in patients undergoing concomitant open heart surgery.

CASE PRESENTATION

A 2-year-old child with Down syndrome underwent concomitant repair of Morgagni hernia and closure of his ventricular septal defect under cardiopulmonary bypass. The hernia was corrected by the sternotomy approach, without opening the hernia content, before the correction of the cardiac pathology. The patient made an uneventful recovery and was discharged on the 4th postoperative day.

DISCUSSION

Preoperative diagnosis of diaphragmatic hernia in congenital heart disease is important to decrease mortality rate. However, trans-sternal exposure of the defect is also possible, as in this case, in patients undergoing open heart surgery for congenital cardiac defects. The defect can be repaired by this approach, concomitantly with the cardiac anomaly, no need for an additional incision and without opening the hernia sac.

CONCLUSION

Our experience, although very limited, in patients who are suffering from Morgagni hernia and concomitant congenital heart defects shows that simultaneous repair of Morgagni hernia through midline sternotomy prior to cardiac procedure is effective. As Morgagni hernia can be accompanied with many congenital cardiac anomalies, cardiac surgeons should be familiar with the trans-sternal approach to the defect.

Laparoscopic treatment of a rare right diaphragmatic rupture with small bowel herniation after blunt thoracic trauma

Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence from 0,8%-1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture.

Laparoscopic Treatment of Morgagni-Larrey Hernia: Technical Details and Report of a Series

Three patients with Morgagni-Larrey hernia were admitted to the surgical department between August 2000 and September 2003 with slight chest pain and dyspnea. Laparoscopic repair of the diaphragmatic hernia was performed using a tension-free closure of the defects with either Vicryl-Prolene or dual facing mesh fixed by Prolene extracorporeal knots and Endostitch devices. The patients were discharged on postoperative day 5 without complications. Mean follow-up has been 23 months (range, 15-36 months) and no recurrence or morbidity related to the procedure has been seen. Laparoscopic repair of Morgagni-Larrey hernia represents an attractive alternative to open surgery. The benefits are gentle and easy manipulation of the content of the sac, reduced surgical trauma, and rapid and uneventful recovery.