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Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement

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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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Correspondence to J. M. Ryan.

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Authors Jessica M. Ryan, Ailín C. Rogers, Enda J. Hannan, Achille Mastrosimone, and Mayilone Arumugasamy have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Online resource 1 An intra-operative video demonstrating laparoscopic repair of a Morgagni hernia using a combination of primary closure and placement of an onlay composite mesh (MOV 168639 kb)

Online resource 1 An intra-operative video demonstrating laparoscopic repair of a Morgagni hernia using a combination of primary closure and placement of an onlay composite mesh (MOV 168639 kb)

Supplementary material 2 (JPEG 48 kb)

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Ryan, J.M., Rogers, A.C., Hannan, E.J. et al. Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement. Hernia 22, 697–705 (2018). https://doi.org/10.1007/s10029-018-1760-x

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Keywords

  • Upper gastrointestinal tract
  • Morgagni
  • Congenital diaphragmatic hernia
  • Diaphragmatic hernia
  • Surgical mesh
  • Surgical procedures