Link: https://www.ncbi.nlm.nih.gov/pubmed/30296422

Ann Thorac Surg. 2018 Oct 5. pii: S0003-4975(131365-1. doi: 10.1016/j.athoracsur.2018.08.021. [Epub ahead of print]
Comparison of Laparoscopic Versus Open Surgical Management of Morgagni Hernia.
Young MC1, Saddoughi SA2, Aho JM2, Harmsen WS3, Allen MS2, Blackmon SH2, Cassivi SD2, Nichols FC2, Shen KR2, Wigle DA2.
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Abstract
BACKGROUND:
Morgagni hernias are rare congenital diaphragmatic hernias that often do not become clinically significant until adulthood. The purpose of this study was to characterize the pre-operative findings and describe surgical outcomes of Morgagni hernia repair based on operative approach.

METHODS:
Retrospective chart review from 1987 to 2015 of patients who underwent repair of a Morgagni hernia. Medical records were reviewed for demographics, symptoms, comorbidities, surgical approach, hospital course, complications, and preoperative imaging.

RESULTS:
43 cases were identified, 23 male and 20 female. Median age was 50.4 years and median BMI was 33.1. Most common presenting symptoms were respiratory (35.7%), and gastrointestinal (28.6%). Although 83.3% of cases were newly diagnosed, none required emergent repair. Pre-operative imaging demonstrated an average hernia size of 8.2 cm. Surgical approaches included laparotomy(62.8%), laparoscopic(23.3%), and thoracotomy(14%). Primary hernia repair was most common(72%). Comparing laparotomy, thoracotomy, and laparoscopic approaches, mesh repair was more common with laparoscopy(p=0.005), operative time was shortest with laparotomy (p=0.029), and hospital length of stay was shortest with laparoscopy (p=0.024). The most common complication was incisional/port site hernia, with no statistical significance between surgical approaches. There was one Morgagni hernia recurrence.

CONCLUSIONS:
Morgagni hernias often present with respiratory and GI symptoms and require repair. All cases in our series were repaired electively. Regardless of approach, recurrence rate was low (2.3%) and complication rate was similar between laparoscopic, laparotomy and thoracotomy. Given the shorter length of stay with similar recurrence rates, a laparoscopic approach is a viable option for repair of Morgagni hernia.

Copyright © 2018. Published by Elsevier Inc.

PMID: 30296422 DOI: 10.1016/j.athoracsur.2018.08.021
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