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A novel approach for the treatment of Morgagni hernias: robotic transabdominal preperitoneal diaphragmatic hernia repair

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Abstract

Purpose

We introduce a novel approach to the surgical repair of Morgagni hernias (MHs) utilizing the robotic transabdominal preperitoneal repair (rTAPP) approach. Borrowed from our previous and robust experience with rTAPP repairs for hernias of the anterior abdominal wall, this technique boasts the benefits of hernia sac reduction, the use of an uncoated mesh in an extraperitoneal plane, and minimal fixation leading to lower postoperative pain relative to other approaches.

Methods

To evaluate the effectiveness of this novel approach, five consecutive symptomatic Morgagni hernias (MHs) were repaired with the rTAPP approach. The size of the defect, mesh size, length of stay, follow-up imaging, and follow-up complications were documented for comparison.

Results

The size of the MH defects ranged from 4 × 6 cm to 5 × 10 cm. LOS was an average of 1.2 days. Two out of the five patients underwent concomitant repair of a lower abdominal hernias (one Spigelian hernia, and one indirect inguinal hernia). Outpatient follow-up from surgery ranged anywhere from 6 months to 4 years, with most patients receiving follow-up after 1 year. Four out of the five patients received follow-up CT scans to confirm the absence of hernia recurrence. One patient experienced an incisional hernia from the midline 12-mm port site which was repaired 1 year after.

Conclusion

We propose a new technique for a minimally invasive strategy to treat these complex hernias utilizing an rTAPP technique resulting in minimal length of stay and a durable result in long-term follow-up. The benefits of repair, which include minimal postoperative pain, minimal length of stay, and cost-effective prosthetic mesh hidden from the visceral contents, are consistent with the author’s experience for rTAPP repairs for hernias of the anterior abdominal wall.

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Authors and Affiliations

  1. Deparment of Surgery, Mayo Clinic School of Graduate Medical Education Arizona, Phoenix, AZ, USA

    N. Sioda

  2. Department of Surgery, Creighton University School of Graduate Medical Education, St. Joseph’s Hospital, 500 W Thomas Rd Ste 400, Phoenix, AZ, USA

    S. Liu, C. Janowski, A. Gamble & C. Ballecer

  3. Department of Surgery, Boston Medical Center School of Graduate Medical Education, Boston, MA, USA

    C. Abdo

  4. Department of Surgery, University of Washington School of Graduate Medical Education, Seattle, WA, USA

    A. Wakim

Authors
  1. N. Sioda
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  2. S. Liu
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  3. C. Janowski
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  4. A. Gamble
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  5. C. Abdo
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  6. A. Wakim
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  7. C. Ballecer
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Corresponding author

Correspondence to C. Ballecer.

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Conflict of Interest

Conrad Ballecer: Consultant for Intuitive Surgical and Medtronic. Natasha A Sioda, Siwen Liu, Courtney Janowski, Alice Gamble, Chris Abdo, and Andre A Wakim declare that they have no conflict of interest.

Ethical Approval

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

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors. The published work is retrospective in scope and does not involve ongoing human subject studies.

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For this retrospective review, formal consent is not required.

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Sioda, N., Liu, S., Janowski, C. et al. A novel approach for the treatment of Morgagni hernias: robotic transabdominal preperitoneal diaphragmatic hernia repair. Hernia 26, 355–361 (2022). https://doi.org/10.1007/s10029-021-02472-y

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  • DOI: https://doi.org/10.1007/s10029-021-02472-y

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