Skip to main content

Advertisement

SpringerLink
Log in

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

  • How-I-Do-It
  • Published:
Hernia Aims and scope Submit manuscript

A Comment to this article was published on 04 May 2018

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Behr G (2013) Congenital diaphragmatic hernia. In: Reid J (ed) Pediatric radiology. Oxford University Press, New York, pp 33–36

    Google Scholar 

  2. Morgagni G (1761) De sedibus et causis morborum per anatomen indagatis libri quinque. Venetiis: ex Thypographia Remondiniana

  3. Morgagni G (1769) The seats and causes of diseases investigated by anatomy; in five books, containing a great variety of dissections, with remarks. To which are added very accurate and copious indexes of the principal things and names therein contained, vol. 3. London, Printed for A. Millar, and T. Cadell, his successor [etc.]

  4. Minneci PC, Deans KJ, Kim P, Mathisen DJ (2004) Foramen of Morgagni hernia: changes in diagnosis and treatment. Ann Thorac Surg 77(6):1956–1959. https://doi.org/10.1016/j.athoracsur.2003.12.028

    Article  PubMed  Google Scholar 

  5. Congenital Diaphragmatic Hernia (2016) EBSCO Information Services. http://www.dynamed.com.proxy.library.rcsi.ie/login.aspx?direct=true&site=DynaMed&id=114158. Registration and login required. Accessed 09 Apr 2017

  6. McGivern MR, Best KE, Rankin J, Wellesley D, Greenlees R, Addor MC, Arriola L, de Walle H, Barisic I, Beres J, Bianchi F, Calzolari E, Doray B, Draper ES, Garne E, Gatt M, Haeusler M, Khoshnood B, Klungsoyr K, Latos-Bielenska A, O’Mahony M, Braz P, McDonnell B, Mullaney C, Nelen V, Queisser-Luft A, Randrianaivo H, Rissmann A, Rounding C, Sipek A, Thompson R, Tucker D, Wertelecki W, Martos C (2015) Epidemiology of congenital diaphragmatic hernia in Europe: a register-based study. Arch Dis Child Fetal Neonatal Ed 100(2):F137–F144. https://doi.org/10.1136/archdischild-2014-306174

    Article  PubMed  Google Scholar 

  7. Horton JD, Hofmann LJ, Hetz SP (2008) Presentation and management of Morgagni hernias in adults: a review of 298 cases. Surg Endosc 22(6):1413–1420. https://doi.org/10.1007/s00464-008-9754-x

    Article  PubMed  Google Scholar 

  8. Kuster GG, Kline LE, Garzo G (1992) Diaphragmatic hernia through the foramen of Morgagni: laparoscopic repair case report. J Laparoendosc Surg 2(2):93–100

    Article  PubMed  CAS  Google Scholar 

  9. Thoman DS, Hui T, Phillips EH (2002) Laparoscopic diaphragmatic hernia repair. Surg Endosc Other Interv Tech 16(9):1345–1349. https://doi.org/10.1007/s00464-001-8162-2

    Article  CAS  Google Scholar 

  10. Rau HG, Schardey HM, Lange V (1994) Laparoscopic repair of a Morgagni hernia. Surg Endosc 8(12):1439–1442

    Article  PubMed  CAS  Google Scholar 

  11. Hasson HM (1971) A modified instrument and method for laparoscopy. Am J Obstet Gynecol 110(6):886–887

    Article  PubMed  CAS  Google Scholar 

  12. Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR, Herts BR, Israel GM, Krinsky G, Platt JF, Shuman WP, Taylor AJ (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7(10):754–773. https://doi.org/10.1016/j.jacr.2010.06.013

    Article  PubMed  Google Scholar 

  13. Shakya VC (2015) Simultaneous laparoscopic management of Morgagni hernia and cholelithiasis: two case reports. BMC Res Notes 8:283. https://doi.org/10.1186/s13104-015-1249-y

    Article  PubMed  PubMed Central  Google Scholar 

  14. Szentkereszty Z, Csaky G, Boland MG, Weisz R, Sasi-Szabo L, Gamal EM, Sapy P (2006) Laparoscopic treatment of simultaneously occurring Morgagni and paraesophageal hernias. J Laparoendosc Adv Surg Tech Part A 16(6):626–628. https://doi.org/10.1089/lap.2006.16.626

    Article  Google Scholar 

  15. Edye M, Salky B, Posner A, Fierer A (1998) Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia. Surg Endosc 12(10):1259–1263

    Article  PubMed  CAS  Google Scholar 

  16. Dallemagne B, Quero G, Lapergola A, Guerriero L, Fiorillo C, Perretta S (2017) Treatment of giant paraesophageal hernia: pro laparoscopic approach. Hernia J Hernias Abdom wall Surg. https://doi.org/10.1007/s10029-017-1706-8

    Article  Google Scholar 

  17. Jakhmola C, Kumar V (2015) Laparoscopic mesh repair of Morgagni hernia in an octogenarian patient. Med J Armed Forces India 71(1):79–81. https://doi.org/10.1016/j.mjafi.2012.06.017

    Article  PubMed  CAS  Google Scholar 

  18. Kelly MD (2007) Laparoscopic repair of strangulated Morgagni hernia. World J Emerg Surg WJES 2:27. https://doi.org/10.1186/1749-7922-2-27

    Article  PubMed  Google Scholar 

  19. Loong TP, Kocher HM (2005) Clinical presentation and operative repair of hernia of Morgagni. Postgrad Med J 81(951):41–44. https://doi.org/10.1136/pgmj.2004.022996

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Pironi D, Palazzini G, Arcieri S, Candioli S, Manigrasso A, Panarese A, Filippini A (2008) Laparoscopic diagnosis and treatment of diaphragmatic Morgagni hernia. Case report and review of the literature. Ann Ital Chir 79(1):29–36

    PubMed  Google Scholar 

  21. Nguyen T, Eubanks PJ, Nguyen D, Klein SR (1998) The laparoscopic approach for repair of Morgagni hernias. JSLS J Soc Laparoendosc Surg 2(1):85–88

    CAS  Google Scholar 

  22. Badic B, Bail JP (2017) Laparoscopic repair of Morgagni hernia—a video vignette. Colorectal Dis 19(3):302. https://doi.org/10.1111/codi.13615

    Article  PubMed  CAS  Google Scholar 

  23. Dell’Abate P, Bertocchi E, Dalla Valle R, Viani L, Del Rio P, Sianesi M (2016) Iatrogenic diaphragmatic hernia following laparoscopic left colectomy for splenic flexure cancer an unusual complication. Annali italiani di chirurgia 87

  24. Kim DK, Moon HS, Jung HY, Sung JK, Gang SH, Kim MH (2017) An incidental discovery of Morgagni hernia in an elderly patient presented with chronic dyspepsia. Korean J Gastroenterol Taehan Sohwagi Hakhoe chi 69(1):68–73. https://doi.org/10.4166/kjg.2017.69.1.68

    Article  PubMed  Google Scholar 

  25. Godazandeh G, Mokhtari-Esbuie F (2016) Laparoscopic repair of Morgagni hernia: three-case presentation and the literature. Case Rep Surg 2016:4268539. https://doi.org/10.1155/2016/4268539

    Article  PubMed  PubMed Central  Google Scholar 

  26. Oguma J, Ozawa S, Kazuno A, Nitta M, Ninomiya Y (2017) Laparoscopic mesh repair of adult diaphragmatic hernia: a report of two cases. Asian J Endosc Surg 10(2):179–182. https://doi.org/10.1111/ases.12345

    Article  PubMed  Google Scholar 

  27. Razi K, Light D, Horgan L (2016) Emergency repair of Morgagni hernia with partial gastric volvulus: our approach. J Surg Case Rep. https://doi.org/10.1093/jscr/rjw151

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhou ZL, Li H, Li JF, Liu YG, Wang C, Wang J (2016) A rare case of laparoscopic repair of simultaneously occurring Morgagni and paraesophageal hernias. Ann Thorac Cardiovasc Surg 22(2):112–115. https://doi.org/10.5761/atcs.cr.15-00159

    Article  PubMed  Google Scholar 

  29. Li S, Liu X, Shen Y, Wang H, Feng M, Tan L (2015) Laparoscopic repair of Morgagni hernia by artificial pericardium patch in an adult obese patient. J Thorac Dis 7(4):754–757. https://doi.org/10.3978/j.issn.2072-1439.2015.03.15

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Ikarashi M, Matsuda M, Murayama I, Fujii M, Takayama T (2015) Laparoscopic repair of Morgagni hernia with composite mesh in an elderly woman: report of a case. Asian J Endosc Surg 8(2):216–218. https://doi.org/10.1111/ases.12161

    Article  PubMed  Google Scholar 

  31. Chamary SL, Chamary VL (2015) Laparoscopic features and repair of a combined left Spigelian hernia and left Morgagni diaphragmatic hernia. Ann R Coll Surg Engl 97(2):e25–e26. https://doi.org/10.1308/003588414x14055925060596

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Kashiwagi H, Kumagai K, Nozue M, Terada Y (2014) Morgagni hernia treated by reduced port surgery. Int J Surg Case Rep 5(12):1222–1224. https://doi.org/10.1016/j.ijscr.2014.11.047

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kaida T, Ikeda A, Shimoda H, Sako H, Uchida H, Wada M, Ikeda K, Okusawa S, Watanabe M (2014) Laparoscopic mesh repair of a Morgagni hernia using the double-crown technique: a case study. Asian J Endosc Surg 7(4):323–326. https://doi.org/10.1111/ases.12120

    Article  PubMed  Google Scholar 

  34. Nunez Garcia E, Arriola Sanchez J, Sanchez Jauredini G, Baley Spindel I (2014) Laparoscopic management of a congenital diaphragmatic hernia. Gac Med Mex 150(5):461–464

    PubMed  Google Scholar 

  35. Park A, Doyle C (2014) Laparoscopic Morgagni hernia repair: how I do it. J Gastrointest Surg 18(10):1858–1862. https://doi.org/10.1007/s11605-014-2552-y

    Article  PubMed  Google Scholar 

  36. Tone K, Kiryu I, Yoshida M, Tsuboi K, Takagi M, Kuwano K (2014) Morgagni hernia with respiratory failure aggravated by noninvasive positive pressure ventilation: a case report and overview of the literature. Respir Investig 52(3):203–208. https://doi.org/10.1016/j.resinv.2013.11.001

    Article  PubMed  Google Scholar 

  37. Chen Y, Wykes J, Haveman JW, Apostolou C, Merrett ND (2013) Laparoscopic repair of Morgagni hernia: an interesting case and complication. ANZ J Surg 83(9):688–689. https://doi.org/10.1111/ans.12219

    Article  PubMed  Google Scholar 

  38. Chiou G, Tedesco M, Eisenberg D (2012) Concurrent laparoscopic morgagni hernia repair and sleeve gastrectomy. J Laparoendosc Adv Surg Tech Part A 22(10):999–1002. https://doi.org/10.1089/lap.2012.0293

    Article  Google Scholar 

  39. Godazandeh G, Mortazian M (2012) Laparoscopic repair of Morgagni hernia using polyvinylidene fluoride (PVDF) Mesh. Middle East J Dig Dis 4(4):232–235

    PubMed  PubMed Central  Google Scholar 

  40. Chick JF, Chauhan NR, Lai JH, Khurana B (2012) Incarcerated Morgagni hernia mimicking acute cholecystitis. Intern Emerg Med 7(Suppl 2):S169–S171. https://doi.org/10.1007/s11739-012-0818-5

    Article  PubMed  Google Scholar 

  41. Terrosu G, Brizzolari M, Intini S, Cattin F, Bresadola V, De Anna D (2012) Morgagni hernia: technical variation in the laparoscopic treatment. Ann Ital Chir 83(5):415–420

    PubMed  Google Scholar 

  42. Yamaguchi S, Marshall MB (2013) Outpatient laparoscopic repair of a Morgagni hernia. Surg Innov 20(6):Np38–Np39. https://doi.org/10.1177/1553350612444170

    Article  PubMed  Google Scholar 

  43. Vassileva CM, Shabosky J, Boley T, Hazelrigg S (2012) Morgagni hernia presenting as a right middle lobe compression. Ann Thorac Cardiovasc Surg 18(1):79–81

    Article  PubMed  Google Scholar 

  44. Stone ML, Julien MA, Dunnington GH Jr, Lau CL (2012) Novel laparoscopic hernia of Morgagni repair technique. J Thorac Cardiovasc Surg 143(3):744–745. https://doi.org/10.1016/j.jtcvs.2011.07.048

    Article  PubMed  Google Scholar 

  45. Rattay T, Ubhi S (2011) Morgagni hernia–an uncommon cause of gastric outlet obstruction. BMJ Case Rep 2011. https://doi.org/10.1136/bcr.05.2011.4264

    Article  Google Scholar 

  46. Misra RP, Schwartz JD (2011) A simplified technique of full-thickness transabdominal laparoscopic repair of Morgagni hernia. J Thorac Cardiovasc Surg 141(2):594–595. https://doi.org/10.1016/j.jtcvs.2010.06.046

    Article  PubMed  Google Scholar 

  47. Kim HR, Hong TH, Lee YS, Kim JJ, Lee BI, Lee KH, Oh SJ, Park SM, Kim YH (2009) Elective laparoscopic repair after colonoscopic decompression for incarcerated morgagni hernia. Gut Liver 3(4):318–320. https://doi.org/10.5009/gnl.2009.3.4.318

    Article  PubMed  PubMed Central  Google Scholar 

  48. Altinkaya N, Parlakgumus A, Koc Z, Ulusan S (2010) Morgagni hernia: diagnosis with multidetector computed tomography and treatment. Hernia J Hernias Abdom Wall Surg 14(3):277–281. https://doi.org/10.1007/s10029-009-0608-9

    Article  CAS  Google Scholar 

  49. Puglisi F, Capuano P, Iambrenghi OC, Armenise N, Carlucci F, Memeo M, Memeo R, Martines G (2009) Laparoscopic repair of Morgagni hernia in an adult: use of a porcine small intestine submucosa biocompatible prosthesis. Chir Ital 61(3):351–356

    PubMed  Google Scholar 

  50. Palanivelu C, Rangarajan M, Rajapandian S, Amar V, Parthasarathi R (2009) Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study. Surg Endosc 23(5):978–985. https://doi.org/10.1007/s00464-008-0294-1

    Article  PubMed  Google Scholar 

  51. Rashid F, Chaparala R, Ahmed J, Iftikhar SY (2009) Atypical right diaphragmatic hernia (hernia of Morgagni), spigelian hernia and epigastric hernia in a patient with Williams syndrome: a case report. J Med Case Rep 3:7. https://doi.org/10.1186/1752-1947-3-7

    Article  PubMed  PubMed Central  Google Scholar 

  52. Pallati PK, Puri V, Mittal SK (2008) Gastric outlet obstruction secondary to Morgagni hernia: a case report. Hernia J Hernias Abdom Wall Surg 12(2):209–212. https://doi.org/10.1007/s10029-007-0287-3

    Article  CAS  Google Scholar 

  53. De Paolis P, Mazza L, Maglione V, Fronda GR (2007) Laparoscopic repair of Morgagni hernia and cholecystectomy in a 40-year-old male with Down’s sindrome. Report of a case. Minerva Chir 62(3):197–200

    PubMed  Google Scholar 

  54. Durak E, Gur S, Cokmez A, Atahan K, Zahtz E, Tarcan E (2007) Laparoscopic repair of Morgagni hernia. Hernia J Hernias Abdom Wall Surg 11(3):265–270. https://doi.org/10.1007/s10029-006-0178-z

    Article  CAS  Google Scholar 

  55. Perez Lara FJ, Lobato Bancalero LA, Moreno Ruiz J, de Luna Diaz R, Hernandez Carmona J, Doblas Fernandez J, Oliva Munoz H (2006) Morgagni hernia associated to hiatus hernia. Laparoscopic repair. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 98(10):789–790

    CAS  Google Scholar 

  56. Dapri G, Himpens J, Hainaux B, Roman A, Stevens E, Capelluto E, Germay O, Cadiere GB (2007) Surgical technique and complications during laparoscopic repair of diaphragmatic hernias. Hernia J Hernias Abdom Wall Surg 11(2):179–183. https://doi.org/10.1007/s10029-006-0161-8

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland

    J. M. Ryan, A. C. Rogers, E. J. Hannan, A. Mastrosimone & M. Arumugasamy

Authors
  1. J. M. Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. C. Rogers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. J. Hannan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Mastrosimone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Arumugasamy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. M. Ryan.

Ethics declarations

Conflict of interest

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

Ethical approval

No ethical approval was required for this study.

Human and animal rights

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

Informed consent

As all cases are anonymised, informed consent was not required.

Electronic supplementary material

Below is the link to the electronic supplementary material.

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)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-018-1760-x

Keywords

Search

Navigation