Skip to main content
SpringerLink
Log in

Laparoscopic management of symptomatic congenital diaphragmatic hernia of Morgagni in the adult

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Currently, there is a relative paucity of literature regarding the management of symptomatic congenital diaphragmatic hernia of the foramen of Morgagni in the adult. This study aims to describe our unique surgical technique and outcomes in adult patients undergoing laparoscopic repair of symptomatic Morgagni hernia.

Methods

This is a retrospective review of adult patients from 2003 to 2020 who underwent a laparoscopic Morgagni hernia repair at our institution. All patients underwent a similar laparoscopic approach, utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect and mesh reinforcement with permanent mesh if the primary repair was subjectively under tension.

Results

The study population consisted of 12 consecutive patients with a Morgagni hernia. Patients presented with a variety of symptoms attributed to the hernia, including pain 83% (n = 10), respiratory symptoms and shortness of breath 58% (7), and gastrointestinal obstruction 25% (3). Other complaints included: nausea 33% (4), reflux 50% (6), early satiety 8% (1), palpitations 16% (2), a gurgling sensation in the chest 8% (1), and weight loss 8% (1). Primary repair was possible in all patients following complete reduction of hernia contents including the hernia sac. Mesh reinforcement was used in 5 of 12 patients. Average surgical operative time was 93 (± 37) min. Median length of stay was 1.3 days (range 0.5–5.5 days). At a median follow-up of 10.9 months (IQR 8.0–41.5 months), all symptoms attributed to the hernia had resolved. No recurrences were identified.

Conclusions

Adults with symptomatic Morgagni hernia should undergo surgical repair. A laparoscopic approach utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect (when possible), with or without mesh reinforcement can be performed safely and effectively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Stege G, Fenton A, Jaffray B (2003) Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatrics 112:532–535

    Article  Google Scholar 

  2. Robinson PD, Fitzgerald DA (2007) Congenital diaphragmatic hernia. Paediatr Respir Rev 8:323–335. https://doi.org/10.1016/j.prrv.2007.08.004

    Article  PubMed  Google Scholar 

  3. 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 15:608–611. https://doi.org/10.1093/icvts/ivs203

    Article  PubMed  PubMed Central  Google Scholar 

  4. Misra RP, Schwartz JD (2011) A simplified technique of full-thickness transabdominal laparoscopic repair of Morgagni hernia. J Thorac Cardiovasc Surg 141:594–595. https://doi.org/10.1016/j.jtcvs.2010.06.046

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Thoman DS, Hui T, Phillips EH (2002) Laparoscopic diaphragmatic hernia repair. Surg Endosc 16:1345–1349. https://doi.org/10.1007/s00464-001-8162-2

    Article  CAS  PubMed  Google Scholar 

  7. Ambrogi V, Forcella D, Gatti A, Vanni G, Mineo TC (2007) Transthoracic repair of Morgagni’s hernia: a 20-year experience from open to video-assisted approach. Surg Endosc 21:587–591. https://doi.org/10.1007/s00464-006-9017-7

    Article  CAS  PubMed  Google Scholar 

  8. Torfs CP, Curry CJ, Bateson TF, Honoré LH (1992) A population-based study of congenital diaphragmatic hernia. Teratology 46:555–565. https://doi.org/10.1002/tera.1420460605

    Article  CAS  PubMed  Google Scholar 

  9. Yang W, Carmichael SL, Harris JA, Shaw GM (2006) Epidemiologic characteristics of congenital diaphragmatic hernia among 2.5 million California births, 1989–1997. Birth Defects Res Part A Clin Mol Teratol 76:170–174. https://doi.org/10.1002/bdra.20230

    Article  CAS  Google Scholar 

  10. Balayla J, Abenhaim HA (2014) Incidence, predictors and outcomes of congenital diaphragmatic hernia: a population-based study of 32 million births in the United States. J Matern Fetal Neonatal Med 27:1438–1444. https://doi.org/10.3109/14767058.2013.858691

    Article  PubMed  Google Scholar 

  11. McGivern MR, Best KE, Rankin J, Wellesley D, Greenlees R, Addor M-C, Arriola L, de Walle H, Barisic I, Beres J, Bianchi F, Calzolari E, Doray B, Draper ES, Garne E, Gatt M, Haeusler M, Khoshnood B, Klungsoyr K, Latos-Bielenska A, O’Mahony M, Braz P, McDonnell B, Mullaney C, Nelen V, Queisser-Luft A, Randrianaivo H, Rissmann A, Rounding C, Sipek A, Thompson R, Tucker D, Wertelecki W, Martos C (2015) Epidemiology of congenital diaphragmatic hernia in Europe: a register-based study. Arch Dis Child Fetal Neonatal Ed 100:F137-144. https://doi.org/10.1136/archdischild-2014-306174

    Article  PubMed  Google Scholar 

  12. Schumacher L, Gilbert S (2009) Congenital diaphragmatic hernia in the adult. Thorac Surg Clin 19:469–472. https://doi.org/10.1016/j.thorsurg.2009.08.004

    Article  PubMed  Google Scholar 

  13. Gale ME (1985) Bochdalek hernia: prevalence and CT characteristics. Radiology 156:449–452. https://doi.org/10.1148/radiology.156.2.4011909

    Article  CAS  PubMed  Google Scholar 

  14. Nayak HK, Maurya G, Kapoor N, Kar P (2012) Delayed presentation of congenital diaphragmatic hernia presenting with intrathoracic gastric volvulus: a case report and review. BMJ Case Rep. https://doi.org/10.1136/bcr-2012-007332

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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 90:694–695. https://doi.org/10.1308/003588408X321693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Altinkaya N, Parlakgümüş A, Koc Z, Ulusan S (2010) Morgagni hernia: diagnosis with multidetector computed tomography and treatment. Hernia 14:277–281. https://doi.org/10.1007/s10029-009-0608-9

    Article  CAS  PubMed  Google Scholar 

  17. Campos L, Sipes E (1991) Laparoscopic repair of diaphragmatic hernia. J Laparoendosc Surg 1(6):369–373. https://doi.org/10.1089/lps.1991.1.369

    Article  CAS  PubMed  Google Scholar 

  18. Akkoyun I, Keçecioğlu M (2012) A new, easy, and safe suturing technique for laparoscopic repair of Morgagni hernias. J Pediatr Surg 47:1626–1628. https://doi.org/10.1016/j.jpedsurg.2012.04.007

    Article  PubMed  Google Scholar 

  19. Alqahtani A, Al-Salem AH (2011) Laparoscopic-assisted versus open repair of Morgagni hernia in infants and children. Surg Laparosc Endosc Percutan Tech 21:46–49. https://doi.org/10.1097/SLE.0b013e318209021f

    Article  PubMed  Google Scholar 

  20. Taskin M, Zengin K, Unal E, Eren D, Korman U (2002) Laparoscopic repair of congenital diaphragmatic hernias. Surg Endosc 16:869. https://doi.org/10.1007/s004640042025

    Article  CAS  PubMed  Google Scholar 

  21. Sherigar JM, Dalal AD, Patel JR (2005) Laparoscopic repair of a Morgagni hernia. J Minim Access Surg 1:76–78. https://doi.org/10.4103/0972-9941.16532

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Durak E, Gur S, Cokmez A, Atahan K, Zahtz E, Tarcan E (2007) Laparoscopic repair of Morgagni hernia. Hernia 11:265–270. https://doi.org/10.1007/s10029-006-0178-z

    Article  CAS  PubMed  Google Scholar 

  23. Percivale A, Stella M, Durante V, Dogliotti L, Serafini G, Saccomani G, Pellicci R (2005) Laparoscopic treatment of Morgagni-Larrey hernia: technical details and report of a series. J Laparoendosc Adv Surg Tech A 15:303–307. https://doi.org/10.1089/lap.2005.15.303

    Article  PubMed  Google Scholar 

  24. Gillespie WF (1943) Physiological principles in the repair of Inguinal Hernia. (The 1942 Lecture of the Royal College of Surgeons of Canada). Can Med Assoc J 49:29–33

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Korkmaz M, Güvenç BH, Senel U (2007) Minimal access surgical repair of Morgagni hernia: the fate of the unresected hernia sac. J Laparoendosc Adv Surg Tech A 17:833–836. https://doi.org/10.1089/lap.2007.0438

    Article  PubMed  Google Scholar 

  26. Palanivelu C, Rangarajan M, Rajapandian S, Amar V, Parthasarathi R (2009) Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study. Surg Endosc 23:978–985. https://doi.org/10.1007/s00464-008-0294-1

    Article  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 77:1956–1959. https://doi.org/10.1016/j.athoracsur.2003.12.028

    Article  PubMed  Google Scholar 

  28. Pironi D, Palazzini G, Arcieri S, Candioli S, Manigrasso A, Panarese A, Filippini A (2008) Laparoscopic diagnosis and treatment of diaphragmatic Morgagni hernia. Case report and review of the literature. Ann Ital Chir 79:29–36

    PubMed  Google Scholar 

  29. Puglisi F, Capuano P, Iambrenghi OC, Armenise N, Carlucci F, Memeo M, Memeo R, Martines G (2009) Laparoscopic repair of Morgagni hernia in an adult: use of a porcine small intestine submucosa biocompatible prosthesis. Chir Ital 61:351–356

    PubMed  Google Scholar 

  30. Kaida T, Ikeda A, Shimoda H, Sako H, Uchida H, Wada M, Ikeda K, Okusawa S, Watanabe M (2014) Laparoscopic mesh repair of a Morgagni hernia using the double-crown technique: a case study. Asian J Endosc Surg 7:323–326. https://doi.org/10.1111/ases.12120

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  32. van Niekerk ML (2013) Laparoscopic Morgagni hernia repair using single-site umbilical and full-thickness abdominal wall repair: technical report of two cases. Afr J Paediatr Surg 10:55–57. https://doi.org/10.4103/0189-6725.109401

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  34. 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 7:754–757. https://doi.org/10.3978/j.issn.2072-1439.2015.03.15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Stone ML, Julien MA, Dunnington GH, Lau CL (2012) Novel laparoscopic hernia of Morgagni repair technique. J Thorac Cardiovasc Surg 143:744–745. https://doi.org/10.1016/j.jtcvs.2011.07.048

    Article  PubMed  Google Scholar 

  36. Dapri G, Himpens J, Hainaux B, Roman A, Stevens E, Capelluto E, Germay O, Cadière GB (2007) Surgical technique and complications during laparoscopic repair of diaphragmatic hernias. Hernia 11:179–183. https://doi.org/10.1007/s10029-006-0161-8

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Utah, 30 North, 1900 East, Salt Lake City, UT, USA

    Elisabeth Leeflang, Jesse Madden, Anna Ibele, Robert Glasgow & Ellen Morrow

Authors
  1. Elisabeth Leeflang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jesse Madden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Ibele
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert Glasgow
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ellen Morrow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ellen Morrow.

Ethics declarations

Disclosures

Elisabeth Leeflang, Jesse Madden, Anna Ibele, Robert Glasgow, and Ellen Morrow declare that they have no conflict of interest.

Ethical approval

University of Utah Institutional Review Board: IRB approval: IRB_00057153.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leeflang, E., Madden, J., Ibele, A. et al. Laparoscopic management of symptomatic congenital diaphragmatic hernia of Morgagni in the adult. Surg Endosc 36, 216–221 (2022). https://doi.org/10.1007/s00464-020-08259-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-08259-z

Keywords

Search

Navigation