Minimally Invasive Transabdominal Repair of Incarcerated Morgagni Hernia in Adults.

Abstract

Objective: Morgagni hernia (MH) is a rare congenital hernia where abdominal organs traverse an embryologic defect. Its presence is an indication for repair.

Methods: A retrospective review was performed. Descriptive statistics characterized the sample. Categorical measures are reported as frequencies and percentages.

Results: Ten patients underwent minimally invasive repair (MIR) of MH (laparoscopic = 2, robotic = 8). There were 4 men and 6 women aged 51-89, with a median of 75 years (IQR 66-78). Seven patients (70%) were symptomatic. MH was unilateral in 9 patients (6 = R, 3 = L) and bilateral in 1. Herniated organs included the colon and omentum for all patients, the small bowel in 2, and the stomach in 1. Length of stay (LOS) for robotic procedures ranged from 1 to 6 days with a median of 2 days (IQR 2-6), while LOS for laparoscopic procedures ranged from 4 to 8 days with a median of 6 days (IQR 4-8). Patient follow-up ranged from 1 to 62 months, with a median of 9.5 months (IQR 3.5-31.5). There were no complications or mortalities.

Conclusion: The majority of adult patients identified with MH are symptomatic, the most common symptom being dyspnea. The colon and omentum are the most commonly herniated organs, although the small bowel and stomach also herniate. MH frequently occurs on the right but can occur on the left or, more rarely, bilaterally. Laparoscopic and robotic approaches to repair can be performed safely and effectively, although a robotic approach may be associated with shorter LOS. MIR is feasible and associated with minimal morbidity and mortality.