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Schembari E, Reitano E, Sofia M, Latteri S, La Greca G. The surgical treatment of Morgagni hernias in adults: a systematic review for the standardization of laparoscopic surgical repair. Updates Surg 2024; 76:839-844. [PMID: 37924436 PMCID: PMC11130068 DOI: 10.1007/s13304-023-01677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/07/2023] [Indexed: 11/06/2023]
Abstract
A Morgagni hernia is a congenital diaphragmatic hernia that is rarely diagnosed in adults, and the technique for its repair has not yet been standardized. This review will give an overview of the different laparoscopic methods reported by other authors, highlighting the key points indicating a good repair to help standardize the technique. A systematic review of the available articles on PubMed was conducted according to PRISMA 2020 by two authors independently in May 2022. Only articles written in English were included. A total of 180 case reports of laparoscopic Morgagni's hernia repair procedures were found; direct repair was performed in 59 patients, mesh was used in 119 patients, and mesh was not used in 2 patients. The hernia sac was removed in 71 patients, and the defect was closed before mesh placement in 49 patients. Nonabsorbable, dual or biologic mesh was used. The mean operative time was 92.65 min for direct repair and 84.11 min for mesh repair. One recurrence was reported in the direct repair series. The optimal method of repair has not yet been identified. The laparoscopic approach is associated to fewer complications and facilitates a faster recovery than the open approach. Several manoeuvres have been reported to help surgeons, who are not trained in laparoscopic knotting, perform extracorporeal knotting. Mesh should be placed when tension is too high after a direct repair or when primary closure cannot be achieved.
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Affiliation(s)
| | - Elisa Reitano
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France
| | - Maria Sofia
- General Surgery, Cannizzaro Hospital, Catania, Italy
| | - Saverio Latteri
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Gaetano La Greca
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
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Ni CH, Li H, Xia CB, Chen YT. Laparoscopic extracorporeal repair without a mesh of parasternal diaphragmatic hernia in an elderly woman: A case report. Medicine (Baltimore) 2018; 97:e13546. [PMID: 30544466 PMCID: PMC6310593 DOI: 10.1097/md.0000000000013546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE The case of parasternal diaphragmatic hernia is relatively rare in adults. The best way for the treatment of diaphragmatic hernia is to receive operation, yet which surgical method is the best remains unclear. PATIENT CONCERNS An elderly woman in the hospital was complaining about upper abdominal pain that was complicated by the parasternal diaphragmatic hernia. Such state was found accidentally in a car accident and diagnosed by a computed tomography (CT) scan. DIAGNOSIS Parasternal diaphragmatic hernia. INTERVENTIONS Laparoscopic surgery was performed. The hernial component was easily drawn back into the abdominal cavity, and hernia sac was resected. Closure hernia sac underwent full-thickness U-shaped transabdominal wall sutures with 3-0 Prolene (ETHICON) after straightening the needle without a mesh. OUTCOMES The patient recovered quickly without postoperative complication. The hospital stay was 2 days. There was no recurrence and symptoms at a 6-month follow-up. LESSONS Laparoscopic extracorporeal repair without using a mesh is a safe, quick, and effective approach. It seems to be an effective treatment of the parasternal diaphragmatic hernia, in particular for elderly patients.
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Abstract
Anteromedial subcostosternal defects, also known as a diaphragmatic hernia of Morgagni (MH), allow potentially life-threatening herniation of the abdominal organs into the thorax. Constituting only a small fraction of all types of congenital diaphragmatic hernias, correct diagnosis of MH is often delayed, owing in large part to nonspecific associated respiratory and gastrointestinal complaints. Once identified, the primary management for both symptomatic and incidentally discovered asymptomatic cases of MH are surgical correction because the herniated contents present increasing risk for strangulation. Various thoracic and abdominal surgical approaches have been described without a clear consensus on preference for operative repair technique. In this article, the literature regarding management of MH within the past decade is reviewed, and an illustrative case of laparoscopic repair of a MH with novel reinforcement using a Falciform ligament onlay flap is presented.
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Affiliation(s)
| | - Adam S Weltz
- 1 Anne Arundel Medical Center, Annapolis, MD, USA
| | | | | | - Nan Wu
- 3 Sutter Gould Medical Foundation, Modesto, CA, USA
| | - Adrian E Park
- 1 Anne Arundel Medical Center, Annapolis, MD, USA.,4 Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Matsudera S, Nakajima M, Takahashi M, Muroi H, Kikuchi M, Shida Y, Ihara K, Yamaguchi S, Sasaki K, Tsuchioka T, Kato H. Laparoscopic surgery for a Bochdalek hernia triggered by pregnancy in an adult woman: A case report. Int J Surg Case Rep 2018; 48:10-15. [PMID: 29763850 PMCID: PMC6066472 DOI: 10.1016/j.ijscr.2018.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/20/2018] [Accepted: 04/26/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A Bochdalek hernia (BH) is a type of congenital diaphragmatic hernia. We herein describe an adult woman with a BH triggered by pregnancy and treated by laparoscopic surgery. PRESENTATION OF CASE A 26-year-old woman was referred to our hospital because of abdominal pain and dyspnea resulting from a left diaphragmatic hernia. She was diagnosed with a BH and underwent laparoscopic surgery. Her postoperative progress was satisfactory, and no recurrence was found at follow-up approximately 1 year later. DISCUSSION A recently published study reviewing detailed cases of laparoscopic and/or thoracoscopic repair of adult BH from 1999 to 2016 identified 30 cases. A laparoscopic approach for treatment of BH has recently attracted increasing interest. CONCLUSION Laparoscopic surgery can be safely performed on adults with BH without complications.
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Affiliation(s)
- Shotaro Matsudera
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan.
| | - Masanobu Nakajima
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | | | - Hiroto Muroi
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Maiko Kikuchi
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yosuke Shida
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Keisuke Ihara
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Satoru Yamaguchi
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Kinro Sasaki
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takashi Tsuchioka
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroyuki Kato
- First Department of Surgery, Dokkyo Medical University, Tochigi, Japan
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Ryan JM, Rogers AC, Hannan EJ, Mastrosimone A, Arumugasamy M. Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement. Hernia 2018; 22:697-705. [PMID: 29556855 DOI: 10.1007/s10029-018-1760-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/10/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Morgagni hernias rarely present in adult life and, thus, little data exist on the optimal method of surgical repair. The laparoscopic approach has grown in popularity since the first reported case in 1992. This article showcases a method for laparoscopic repair of Morgagni hernias using both primary closure and mesh reinforcement. OPERATIVE APPROACH There were three obese women who presented in adulthood with cardiopulmonary symptoms; in all cases, the symptoms were attributable to local compressive effects of large Morgagni hernias. All three hernias were repaired laparoscopically, first by approximating the diaphragm to the fascia of the anterior abdominal wall, followed by insertion of a composite mesh, tacked to the diaphragm, to buttress the closure. All patients had excellent outcomes with symptom resolution. DISCUSSION This case series describes a method of laparoscopic Morgagni hernia repair using primary closure reinforced with a mesh, with excellent postoperative outcomes. Others have described thoracic or open approaches. The authors feel that the method described herein is likely to reduce recurrence in a patient population who are often overweight or obese and, thus, have a high risk of this complication. Furthermore, we discuss all reported laparoscopic repair cases in the literature and highlight the paucity of evidence on the optimal approach.
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Affiliation(s)
- J M Ryan
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland.
| | - A C Rogers
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
| | - E J Hannan
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
| | - A Mastrosimone
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
| | - M Arumugasamy
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
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O'Brien C, Jobling JC. Symptomatic bilateral Morgagni diaphragmatic hernias in an elderly patient. BJR Case Rep 2017; 3:20160110. [PMID: 30363209 PMCID: PMC6159192 DOI: 10.1259/bjrcr.20160110] [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: 08/11/2016] [Revised: 12/22/2016] [Accepted: 01/12/2017] [Indexed: 11/18/2022] Open
Abstract
We present a rare case of bilateral Morgagni hernias in an elderly female patient. She initially presented with coffee-ground vomiting and underwent an OGD from which she was given a diagnosis of oesophagitis. On her second presentation (a year later), CT was performed after OGD to evaluate what was thought to be a complex hiatus hernia causing haematemesis, at which point a diagnosis of bilateral Morgagni hernias was made. Surgical management with laparoscopic mesh repair was performed and she made an uneventful recovery.
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Affiliation(s)
- Cathal O'Brien
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Craig Jobling
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Zhang M, Wang H, Liu D, Pan X, Wu W, Hu Z, Zhang H. Non-intubated laparoscopic repair of giant Morgagni's hernia for a young man. J Thorac Dis 2016; 8:E698-701. [PMID: 27621903 DOI: 10.21037/jtd.2016.07.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An asymptomatic patient was admitted as his chest photograph and computed tomography scans showed a giant Morgagni's hernia (MH). And it was repaired by laparoscopic approach under epidural anesthesia without endotracheal intubation. The hernia content of omentum was repositioned back into the abdominal cavity, and the diaphragmatic defect was repaired with composite mesh. Which indicated that non-intubated laparoscopic mesh repair via epidural anesthesia is reliable and satisfactory for MH.
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Affiliation(s)
- Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Heng Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Dong Liu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Xuefeng Pan
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Wenbin Wu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Zhengqun Hu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Hui Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
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