Laparoscopic-assisted repair of Morgagni hernia in children
Received 11 August 2008; received in revised form 24 October 2008; accepted 24 October 2008.
Abstract
Purpose
Morgagni hernia is a rare entity that accounts for less than 6% of all surgically treated diaphragmatic hernias in pediatric age group. They are mostly asymptomatic and discovered incidentally. Open surgical repair has been the gold standard in all cases once diagnosed. However, since the introduction of minimal access surgery, different laparoscopic techniques of Morgagni hernia repair have been reported in the literatures. Most of them are reporting on few cases and the immediate outcomes. Herein, we report the largest experience to date assessing the safety and efficacy of laparoscopic-assisted full-thickness anterior abdominal wall repair of Morgagni hernia in children with more emphasis on the short-term outcomes, such as the recurrence and the fate of the hernia sac.
Methods
Fifteen children with Morgagni hernias underwent primary laparoscopic repair by placement of interrupted nonabsorbable sutures through the full thickness of the anterior abdominal wall, incorporating the hernia sac, the posterior rim of the defect, and returning back out through the anterior abdominal wall with the sutures tied in the subcutaneous tissue.
Result
Between January 2004 and January 2008, 15 children with Morgagni hernia were treated laparoscopically in our institution-affiliated hospitals. Male-female ratio was 2:1. Mean age was 21.7 months. The average operative time was 42.6 minutes. Average time to full feed was 22.9 hours. Postoperative analgesia requirement was minimal. The average hospital stay was 24 hours. All operations were completed laparoscopically. None of the patients developed intraoperative or postoperative complications. The maximum follow-up was 48 months (mean, 20 months). All patients are in good health without recurrence or significant sac residual.
Conclusion
Laparoscopic-assisted Morgagni hernia repair is a safe and effective modality of treatment. It is well tolerated and gives all the advantages of minimal access surgery, without adverse effects from leaving the sac plicated in place.
ABSTRACT