Laparoscopic Repair Of Incarcerated Morgagni Hernia
OBJECTIVE: To demonstrate a successful laparoscopic transabdominal mesh repair of an incarcerated Morgagni hernia.
INTRODUCTION: An incarcerated Morgagni hernia, the rarest of congenital diaphragmatic hernias, occurs when abdominal viscera herniate through an anterior defect in the diaphragm. Surgical repair of the hernia is recommended to relieve symptoms and prevent strangulation. Here we present a case of laparoscopic surgical repair of a Morgagni hernia using mesh in an obese patient.
METHODS: A 34-year-old morbidly obese female presented with 18 months of intermittent epigastric and chest pain, along with dyspnea, that worsened after eating and before bowel movements. Laboratory work-up was unremarkable. CT imaging revealed an incarcerated Morgagni hernia containing omentum and transverse colon.
PROCEDURE: A laparoscopic repair was subsequently performed with port placement in the RUQ, LUQ, and supraumbilical regions. The hernia sac and its contents were carefully reduced using both sharp and blunt dissection. Due to chronicity and location, the hernia sac was not excised. After clearing the hernia defect of adhesions, it was closed primarily under minimal tension using multiple transfascial-to-hernia defect sutures placed in a U-shaped manner. The repair was reinforced with polypropylene mesh which was secured to the abdominal wall and diaphragm using laparoscopic tacks.
RESULTS: The patient did well post-operatively. She continued to do well both clinically and radiographically at one-year follow-up.
CONCLUSION: An incarcerated Morgagni hernia can be repaired safely and successfully in obese patients using a transabdominal laparoscopic approach with mesh.