Page 45 - Jourmal of World Association of Laparoscopic Surgeon

WJOLS

10.5005/jp-journals-10033-1181
Two Trocar Laparoscopic Repair of Morgagni Hernia in Infant and Childhood: Simplified Technique
SURGICAL TECHNIQUE
Two Trocar Laparoscopic Repair of Morgagni Hernia in

Infant and Childhood: Simplified Technique

Medhat M Ibrahim

ABSTRACT Morgagni duct is existent congenital diaphragmatic hernias
are relatively rare; occurring in 0.02 to 0.05% of live births. 2
Purpose: Morgagni hernia (MH) is a rare entity that accounts
for less than 6% of all surgically treated diaphragmatic hernias Morgagni hernia (MH) is the least common type of
in pediatric age group. They are mostly asymptomatic and congenital diaphragmatic hernia and is often diagnosed
discovered incidentally. Open surgical repair has been the gold incidentally in asymptomatic adults. Since or even before
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standard in all cases. However, since the introduction of minimal
access surgery, different laparoscopic techniques of MH repair birth, a large number of hernias appear later in infant or
have been reported. Most of them are reporting on few cases childhood age. The condition is often asymptomatic but it
and the immediate outcomes. I report one of the largest is often diagnosed incidentally during the investigation of
experiences to date assessing the safety and efficacy two trocars 4
laparoscopic repair of MH in children with more emphasis on other conditions. Diagnosis needs a high index of suspicion
the short-term outcomes, such as the recurrence, conversion as misdiagnosis and noncorrection may end in a catastrophe. 5
rate, operative, postoperative complications and the fate of the Standard surgical procedures for the repair of MH
hernia sac. traditionally require a laparotomy or thoracotomy, but with

Patients and methods: Fifteen children with MHs underwent the recent improvement in minimal invasive surgery
primary laparoscopic repair by placement of U-shaped, instrument and vision, repair can safely be performed
nonabsorbable sutures through the full thickness of the anterior
abdominal wall incorporating, the posterior rim of the defect, laparoscopically. The method of laparoscopic closure of the
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and returning back out through the anterior abdominal wall with defect and the excision of the sac are debatable. Many
the sutures tied in the subcutaneous tissue using the Storz port technique has been described as primarily closure with a
closure needle and without hernia sac excision, no insertion of continuous suture by Fernandez et al, interrupted sutures
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chest tube or drain.
with intracorporeal knot tying, and Ramachandran et al 8
Results: A total of 15 patients with MH were operated upon. laparoscopic-assisted repair of MH by taking full thickness
There were 10 males and 5 females. Left-sided MH was present
in five cases (33%), right-sided MH was present in seven cases of anterior abdominal wall in a U-shaped suture under direct
(47%) and three bilateral MH (20%). Male-female ratio was 2:1. vision with extracorporeal knot tying in the subcutaneous
Intraoperative and postoperative analgesia requirement was tissue is also scribed. 9,10
minimal. All operations were completed laparoscopically. None
of the patients developed intraoperative or postoperative I used laparoscopic two ports and Sorze port closure
complications. The maximum follow-up was 48 months (mean, needle to insert U-shape sutures to close the defect in MH
20 months). All patients are in good health without recurrence of infant and children without excision of the sac or insertion
or significant sac residual. of chest drain. This is simplified technical and can help
Conclusion: This easy save technique of MH repair is reducing surgeons to overcome difficulties of the laparoscopic
the operative time and postoperative hospital stay. Also it is surgery, reduce the number of port and improve the
minims the need of postoperative analgesia. The hernia sac
excision or not is not affecting the outcome. operative outcome. This article describes the operative
technique and its short-term outcome.
Keywords: Laparoscopic, Morgagni hernia.
How to cite this article: Ibrahim MM. Two Trocar Laparoscopic PATIENT AND METHODS
Repair of Morgagni Hernia in Infant and Childhood: Simplified
Technique. World J Lap Surg 2013;6(1):47-51. This study was conducted in Royal Commission Medical
Center (RCMC) Yanbu, KSA between March 2008 and
Source of support: Nil
April 2012. All patients with Morgagni diaphragmatic hernia
Conflict of interest: None declared MH were subjected to thorough clinical examination and

routine laboratory and radiological investigations. The main
INTRODUCTION
outcome measurements were feasibility of the technique,
Morgagni-Larrey type hernia occurs through a weakness in conversion rate, operative time, blood loss, postoperative
the anterior fibers of the diaphragm between its costal and analgesic requirement and hospital stay, fat of the
sternal part, in the muscle free triangular space called the nonexcised hernia sac and recurrence rate. The technique
Larrey space. It is also called retrosternal, parasternal, was approved by the ethical committee of the hospital.
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substernal and subcostosternal hernia. Although the Written detailed informed consent was obtained from all
World Journal of Laparoscopic Surgery, January-April 2013;6(1):47-51 47