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Management of Morgagni’s Hernia in the Adult Population: A Systematic Review of the Literature

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Abstract

Background

Morgagni’s hernia (MH) is defined by the protrusion of abdominal viscera through an anterior retrosternal diaphragmatic defect. The objective of this study was to systematically review current literature on MHs in adult population and assess their clinical characteristics and therapeutic approach.

Methods

PubMed and Cochrane bibliographical databases were searched (last search: 15th January 2021) for studies concerning MHs.

Results

Inclusion criteria were met by 189 studies that included 310 patients (61.0% females) with an age of 57.37 ± 18.41 (mean ± SD) years. Pulmonary symptoms, abdominal pain, and nausea-vomit were among the most frequent symptomatology. MHs were predominantly right-sided (84.0%), with greater omentum (74.5%) and transverse colon (65.1%) being the most commonly herniated viscera. The majority of cases underwent an open procedure, while 42.3% of patients had a minimally invasive procedure. Abdominal approach was mostly preferred, while a thoracic one was chosen at 20.6% of cases and a thoracoabdominal at 3.2%. Thirty-day postoperative complications were recorded at 29 patients and 30-day mortality was 2.3%.

Conclusions

MH is a rare type of congenital diaphragmatic hernia which rarely manifests in adult population with atypical pulmonary and gastrointestinal symptoms. Surgery is the gold standard for their management. Open surgical approach is preferable in emergency cases, while laparoscopic surgery is favored in elective setting and is associated with shorter hospitalization. Further studies are crucial in order to elucidate etiology and optimal therapeutic approach.

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References

  1. Kinoshita F, Ishiyama M, Honda S, Matsuzako M, Oikado K, Kinoshita T, Saida Y (2009) Late-presenting posterior transdiaphragmatic (Bochdalek) hernia in adults: prevalence and MDCT characteristics. J Thorac Imaging 24(1):17–22. https://doi.org/10.1097/RTI.0b013e31818c6bc8

    Article  PubMed  Google Scholar 

  2. Zani A, Cozzi DA (2008) Giovanni Battista Morgagni and his contribution to pediatric surgery. J Pediatr Surg 43(4):729–733. https://doi.org/10.1016/j.jpedsurg.2007.12.065

    Article  PubMed  Google Scholar 

  3. He S, Sade I, Lombardo G, Prabhakaran K (2017) Acute presentation of congenital diaphragmatic hernia requiring damage control laparotomy in an adult patient. J Surg Case Rep. https://doi.org/10.1093/jscr/rjx144

    Article  PubMed  PubMed Central  Google Scholar 

  4. Park A, Doyle C (2014) Laparoscopic Morgagni hernia repair: how I do it. J Gastrointest Surg 18(10):1858–1862. https://doi.org/10.1007/s11605-014-2552-y

    Article  PubMed  Google Scholar 

  5. Harrington SW (1951) Clinical manifestations and surgical treatment of congenital types of diaphragmatic hernia. Rev Gastroenterol 18(4):243–256

    CAS  PubMed  Google Scholar 

  6. Sanford Z, Weltz AS, Brown J, Shockcor N, Wu N, Park AE (2018) Morgagni Hernia Repair: A Review. Surg Innov 25(4):389–399. https://doi.org/10.1177/1553350618777053

    Article  PubMed  Google Scholar 

  7. Simson JN, Eckstein HB (1985) Congenital diaphragmatic hernia: a 20 year experience. Br J Surg 72(9):733–736. https://doi.org/10.1002/bjs.1800720921

    Article  CAS  PubMed  Google Scholar 

  8. Lim L, Gilyard SM, Sydorak RM, Lau ST, Yoo EY, Shaul DB (2019) Minimally Invasive Repair of Pediatric Morgagni Hernias Using Transfascial Sutures with Extracorporeal Knot Tying. Perm J. https://doi.org/10.7812/tpp/18.208

    Article  PubMed  PubMed Central  Google Scholar 

  9. Garriboli M, Bishay M, Kiely EM, Drake DP, Curry JI, Cross KM, Eaton S, De Coppi P, Pierro A (2013) Recurrence rate of Morgagni diaphragmatic hernia following laparoscopic repair. Pediatr Surg Int 29(2):185–189. https://doi.org/10.1007/s00383-012-3199-y

    Article  PubMed  Google Scholar 

  10. Latif Al-Arfaj A (1998) Morgagni’s hernia in infants and children. Eur J Surg 164(4):275–279. https://doi.org/10.1080/110241598750004508

    Article  CAS  PubMed  Google Scholar 

  11. Aydin Y, Altuntas B, Ulas AB, Daharli C, Eroglu A (2014) Morgagni hernia: transabdominal or transthoracic approach? Acta Chir Belg 114(2):131–135

    Article  CAS  Google Scholar 

  12. Arora S, Haji A, Ng P (2008) Adult Morgagni hernia: the need for clinical awareness, early diagnosis and prompt surgical intervention. Ann R Coll Surg Engl 90(8):694–695. https://doi.org/10.1308/003588408x321693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Chen Y, Wykes J, Haveman JW, Apostolou C, Merrett ND (2013) Laparoscopic repair of Morgagni hernia: an interesting case and complication. ANZ J Surg 83(9):688–689. https://doi.org/10.1111/ans.12219

    Article  PubMed  Google Scholar 

  14. Maish MS (2010) The diaphragm. Surg Clin North Am 90(5):955–968. https://doi.org/10.1016/j.suc.2010.07.005

    Article  PubMed  Google Scholar 

  15. Comer TP, Clagett OT (1966) Surgical treatment of hernia of the foramen of Morgagni. J Thorac Cardiovasc Surg 52(4):461–468

    Article  CAS  Google Scholar 

  16. Swain JM, Klaus A, Achem SR, Hinder RA (2001) Congenital diaphragmatic hernia in adults. Semin Laparosc Surg 8(4):246–255

    Article  CAS  Google Scholar 

  17. Ackroyd R, Watson DI (2000) Laparoscopic repair of a hernia of Morgagni using a suture technique. J R Coll Surg Edinb 45(6):400–402

    CAS  PubMed  Google Scholar 

  18. Catalona WJ, Crowder WL, Chretien PB (1972) Occurrence of hernia of Morgagni with filial cervical lung hernia: a hereditary defect of the cervical mesenchyme? Chest 62(3):340–342. https://doi.org/10.1378/chest.62.3.340

    Article  CAS  PubMed  Google Scholar 

  19. Lev-Chelouche D, Ravid A, Michowitz M, Klausner JM, Kluger Y (1999) Morgagni hernia: unique presentations in elderly patients. J Clin Gastroenterol 28(1):81–82. https://doi.org/10.1097/00004836-199901000-00022

    Article  CAS  PubMed  Google Scholar 

  20. Eglinton T, Coulter GN, Bagshaw P, Cross L (2006) Diaphragmatic hernias complicating pregnancy. ANZ J Surg 76(7):553–557. https://doi.org/10.1111/j.1445-2197.2006.03776.x

    Article  PubMed  Google Scholar 

  21. Horton JD, Hofmann LJ, Hetz SP (2008) Presentation and management of Morgagni hernias in adults: a review of 298 cases. Surg Endosc 22(6):1413–1420. https://doi.org/10.1007/s00464-008-9754-x

    Article  PubMed  Google Scholar 

  22. Berman L, Stringer D, Ein SH, Shandling B (1989) The late-presenting pediatric Morgagni hernia: a benign condition. J Pediatr Surg 24(10):970–972. https://doi.org/10.1016/s0022-3468(89)80193-9

    Article  CAS  PubMed  Google Scholar 

  23. Ağalar C, Atila K, Arslan N, Derici ZS, Bora S (2018) Adult morgagni hernia: A single-center experience of five cases and a review of literature. Turk J Surg. https://doi.org/10.5152/turkjsurg.2018.3929

    Article  PubMed  Google Scholar 

  24. Yoldas T, Ustun M, Karaca C, Firat O, Caliskan C, Akgun E, Korkut M (2016) Morgagni hernia: is it just a congenital hernia or a cause of emergency surgery? Am Surg 82(11):317–319

    Article  Google Scholar 

  25. Sirmali M, Türüt H, Gezer S, Findik G, Kaya S, Tastepe Y, Cetin G (2005) Clinical and radiologic evaluation of foramen of Morgagni hernias and the transthoracic approach. World J Surg 29(11):1520–1524. https://doi.org/10.1007/s00268-005-0055-4

    Article  PubMed  Google Scholar 

  26. Dalvi AN, Rege SA, Ravikiran CS, Thapar BV, Deshpande AA (2001) Laparoscopic repair of Morgagni hernia in adult. Indian J Gastroenterol 20(2):70

    CAS  PubMed  Google Scholar 

  27. Minneci PC, Deans KJ, Kim P, Mathisen DJ (2004) Foramen of Morgagni hernia: changes in diagnosis and treatment. Ann Thorac Surg 77(6):1956–1959. https://doi.org/10.1016/j.athoracsur.2003.12.028

    Article  PubMed  Google Scholar 

  28. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lawson R (2004) Small sample confidence intervals for the odds ratio. Communications in Statistics-Simulation and Computation 33(4):1095–1113

    Article  Google Scholar 

  30. Li S, Liu X, Shen Y, Wang H, Feng M, Tan L (2015) Laparoscopic repair of Morgagni hernia by artificial pericardium patch in an adult obese patient. J Thorac Dis 7(4):754–757. https://doi.org/10.3978/j.issn.2072-1439.2015.03.15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kumar A, Bhandari RS (2016) Morgagni hernia presenting as gastric outlet obstruction in an elderly male. J Surg Case Rep. https://doi.org/10.1093/jscr/rjw126

    Article  PubMed  PubMed Central  Google Scholar 

  32. Iso Y, Sawada T, Rokkaku K, Furihata T, Shimoda M, Kita J, Kubota K (2006) A case of symptomatic Morgagni’s hernia and a review of Morgagni’s hernia in Japan (263 reported cases). Hernia 10(6):521–524. https://doi.org/10.1007/s10029-006-0123-1

    Article  CAS  PubMed  Google Scholar 

  33. Oppelt PU, Askevold I, Bender F, Liese J, Padberg W, Hecker A, Reichert M (2020) Morgagni-Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience. Hernia. https://doi.org/10.1007/s10029-020-02147-0

    Article  PubMed  PubMed Central  Google Scholar 

  34. Arikan S, Dogan MB, Kocakusak A, Ersoz F, Sari S, Duzkoylu Y, Nayci AE, Ozoran E, Tozan E, Dubus T (2018) Morgagni’s hernia: analysis of 21 patients with our clinical experience in diagnosis and treatment. Indian J Surg 80(3):239–244. https://doi.org/10.1007/s12262-016-1580-0

    Article  PubMed  Google Scholar 

  35. Aghajanzadeh M, Khadem S, Khajeh Jahromi S, Gorabi HE, Ebrahimi H, Maafi AA (2012) Clinical presentation and operative repair of Morgagni hernia. Interact Cardiovasc Thorac Surg 15(4):608–611

    Article  Google Scholar 

  36. Colakoglu O, Haciyanli M, Soyturk M, Colakoglu G, Simsek I (2005) Morgagni hernia in an adult: atypical presentation and diagnostic difficulties. Turk J Gastroenterol 16(2):114–116

    PubMed  Google Scholar 

  37. Eren S, Ciris F (2005) Diaphragmatic hernia: diagnostic approaches with review of the literature. Eur J Radiol 54(3):448–459. https://doi.org/10.1016/j.ejrad.2004.09.008

    Article  PubMed  Google Scholar 

  38. Young MC, Saddoughi SA, Aho JM, Harmsen WS, Allen MS, Blackmon SH, Cassivi SD, Nichols FC, Shen KR, Wigle DA (2019) Comparison of laparoscopic versus open surgical management of morgagni hernia. Ann Thorac Surg 107(1):257–261. https://doi.org/10.1016/j.athoracsur.2018.08.021

    Article  PubMed  Google Scholar 

  39. Tan YW, Banerjee D, Cross KM, De Coppi P, Blackburn SC, Rees CM, Giuliani S, Curry JI, Eaton S (2018) Morgagni hernia repair in children over two decades: institutional experience, systematic review, and meta-analysis of 296 patients. J Pediatr Surg 53(10):1883–1889. https://doi.org/10.1016/j.jpedsurg.2018.04.009

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str., ZIP Code 11527, AthensAthens, Greece

    Ioannis Katsaros, Stamatia Katelani, Spyridon Giannopoulos & Dimitrios Schizas

  2. Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece

    Nikolaos Machairas & Stylianos Kykalos

  3. Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece

    Nikolaos Koliakos & Anargyros Bakopoulos

  4. Intensive Care Unit, Tzaneio General Hospital of Piraeus, Piraeus, Greece

    Emmanouil I. Kapetanakis

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  1. Ioannis Katsaros
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Contributions

Project supervisor: D.S., Conception and design: D.S., S.K., A.B.,Data collection, analysis, and interpretation: I.K., S.K., S.G., N.M., N.K., E.I.K.,Writing the manuscript: I.K., S.K., S.G., N.M., N.K., Critical revision of the manuscript: D.S, S.K., E.I.K., A.B.

Corresponding author

Correspondence to Ioannis Katsaros.

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Conflict of interest

Ioannis Katsaros, Stamatia Katelani, Spyridon Giannopoulos, Nikolaos Machairas, Stylianos Kykalos, Nikolaos Koliakos, Emmanouil I. Kapetanakis, Anargyros Bakopoulos, Dimitrios Schizas declare no conflict of interest.

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Approval from the institutional review board was not required for this type of study.

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This article is a systematic review, and it contains data collected through literature review. It does not include research directly involving human or animal participation.

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For this systematic review, informed consent of individual patients was not necessary.

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Katsaros, I., Katelani, S., Giannopoulos, S. et al. Management of Morgagni’s Hernia in the Adult Population: A Systematic Review of the Literature. World J Surg 45, 3065–3072 (2021). https://doi.org/10.1007/s00268-021-06203-3

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