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Laparoscopic Repair of Morgagni Hernia: Three-Case Presentation and the Literature

View Article: PubMed Central - PubMed

ABSTRACT

Introduction. Morgagni hernia is a rare form of congenital diaphragmatic hernia. Case Presentation. We present three cases of Morgagni hernia with GI symptoms treated by laparoscopic surgery. Discussion. Hernial sac was excised in two cases and left in situ in one case. There was no recurrence in symptoms after 30 months from surgery.

No MeSH data available.


Fixation of mesh to anterior abdominal wall.
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fig5: Fixation of mesh to anterior abdominal wall.

Mentions: Patients were placed in the supine position. A Foley catheter was inserted after general anesthesia. Pneumoperitoneum with carbonic dioxide (CO2) was performed by Veress needle. One 10 mm trocar port was inserted above the umbilicus and a camera (30° angulated optic) was inserted into the abdominal cavity. Two additional trocars (5 mm) were placed at the right and the left of the abdomen, and one 10 mm trocar was placed at the left flank, respectively. Subsequently, patients were putted on the reverse Trendelenburg positions. The anesthesiologist manually inflated the lungs to ensure positive pressure in order to facilitate the reduction of the sac contents. Intraoperatively, hernial sac content (colon, omentum, and part of stomach) was pulled out and reduced back into the abdominal cavity (Figure 3). The falciform ligament was divided and the hernia sac was excised at first two cases by LigaSure (Figure 4), but at operation of the third patient, the hernial sac had not been removed. The size of the defect was 6 × 7 cm in the first patient, 5 × 6 cm in the second patient, and 6 × 6 cm in the third patient. Dual-sided mesh (15 × 20 cm) was inserted into the abdominal cavity through the 10 mm port in all three cases. Mesh was expanded over the defect and fixed to the anterior abdominal wall and edge of the diaphragmatic defect in the posterior part with spiral tacks (Protack®, Covidien, Mansfield, MA, USA) (Figure 5). After removal of the trocars under direct visualization, the fascial incision at the 10 mm trocar sites was closed via sutures. All patients were admitted to the SICU for the first postoperative day and discharged within 48 to 72 hours after surgery. All three cases were discharged ambulatorily and putted on normal diets. There was no complication such pneumomediastinum, fluid collection, or recurrence during 20 to 30 months of follow-up for all patient.


Laparoscopic Repair of Morgagni Hernia: Three-Case Presentation and the Literature
Fixation of mesh to anterior abdominal wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5121438&req=5

fig5: Fixation of mesh to anterior abdominal wall.
Mentions: Patients were placed in the supine position. A Foley catheter was inserted after general anesthesia. Pneumoperitoneum with carbonic dioxide (CO2) was performed by Veress needle. One 10 mm trocar port was inserted above the umbilicus and a camera (30° angulated optic) was inserted into the abdominal cavity. Two additional trocars (5 mm) were placed at the right and the left of the abdomen, and one 10 mm trocar was placed at the left flank, respectively. Subsequently, patients were putted on the reverse Trendelenburg positions. The anesthesiologist manually inflated the lungs to ensure positive pressure in order to facilitate the reduction of the sac contents. Intraoperatively, hernial sac content (colon, omentum, and part of stomach) was pulled out and reduced back into the abdominal cavity (Figure 3). The falciform ligament was divided and the hernia sac was excised at first two cases by LigaSure (Figure 4), but at operation of the third patient, the hernial sac had not been removed. The size of the defect was 6 × 7 cm in the first patient, 5 × 6 cm in the second patient, and 6 × 6 cm in the third patient. Dual-sided mesh (15 × 20 cm) was inserted into the abdominal cavity through the 10 mm port in all three cases. Mesh was expanded over the defect and fixed to the anterior abdominal wall and edge of the diaphragmatic defect in the posterior part with spiral tacks (Protack®, Covidien, Mansfield, MA, USA) (Figure 5). After removal of the trocars under direct visualization, the fascial incision at the 10 mm trocar sites was closed via sutures. All patients were admitted to the SICU for the first postoperative day and discharged within 48 to 72 hours after surgery. All three cases were discharged ambulatorily and putted on normal diets. There was no complication such pneumomediastinum, fluid collection, or recurrence during 20 to 30 months of follow-up for all patient.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction. Morgagni hernia is a rare form of congenital diaphragmatic hernia. Case Presentation. We present three cases of Morgagni hernia with GI symptoms treated by laparoscopic surgery. Discussion. Hernial sac was excised in two cases and left in situ in one case. There was no recurrence in symptoms after 30 months from surgery.

No MeSH data available.