Transabdominal approach in the surgical management of morgagni hernia

Abstract

Purpose. Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far only limited data have been reported. The objective of this retrospective study was to evaluate the outcome of patients presenting with a complicated Morgagni hernia and who undergo a transabdominal repair. Methods. Between September 1999 and October 2005, 11 patients with Morgagni hernia were operated on in our department. Eight of them had acute presentations because of a complicated Morgagni hernia. The patient demographics, presenting symptoms, operative approach, and complications were collected. The postoperative course was evaluated for morbidity and mortality. Results. The patients’ ages ranged from 42 to 85 years (mean 69.4). Two (18.2%) patients were male and nine (81.8%) patients were female. Chest roentgenograms, computed tomography, and contrast meal studies were used as diagnostic utilities. A transabdominal approach was used for all patients. One patient died due to pulmonary failure. The mean follow-up was 2.8 years. There was no recurrence or symptoms regarding the operation in the remaining patients. Conclusion. We recommend the transabdominal approach in patients with Morgagni hernia as it makes it easy to reduce the hernia contents and repair of the hernia sac. Moreover, when complicated with strangulation, incarceration or perforation, a surgical repair through a transabdominal approach is mandatory.

Morgagni hernia is a congenital herniation of the abdominal contents through the retrosternal defect into the thoracic cavity. In 1769 Morgagni first described a diaphragmatic hernia that originated from the sternocostal trigone.1 In 1828 Larrey described a surgical approach to the pericardial cavity through an anterior diaphragmatic defect.2 This triangular space is located between the muscular fibers of xiphosternum and costal margin fibers protruding into the central tendon. The lack of fusion in the anterior part of the pleuroperitoneal membrane and deficiency in the mascularization result in a hernia in this space. The herniation of abdominal contents is typically caused by an increase in intra-abdominal pressure secondary to trauma, pregnancy, and obesity.3 We herein report our experience and the suitability of a transabdominal approach as a surgical procedure in 11 patients with Morgagni hernia.