Robotic transabdominal preperitoneal morgagni hernia repair technique: A case report

Robotic transabdominal preperitoneal Morgagni hernia repair: A step-wise approach. Morgagni hernia (MH) is an atypical and rare type of diaphragmatic hernia that presents surgical challenges given its location and proximity to vital structures. Classically, these hernias have been repaired either open or laparoscopically with the use of an intraperitoneal onlay mesh without defect closure. Borrowing from the groups’ excellent experience in robotic transabdominal preperitoneal hernia repair (rTAPP) ventral and atypically located hernias, this approach has shown promise in repairing MHs in albeit a small cohort of patients. The rTAPP technique in our opinion overcomes many of the challenges and pitfalls associated with atypical hernias, including those of the diaphragm, providing excellent visualization and facilitating wide preperitoneal dissection with a complete reduction of the hernia sac located in the anterior mediastinum. The wide preperitoneal exposure allows for directed diaphragmatic closure, minimizing the risk of injury to mediastinal structures, placement of a large uncoated mesh sandwiched in between layers of the abdominal wall, and safely targeted fixation at cardinal points. Preperitoneal mesh allows for the use of a more cost-effective uncoated mesh that is not exposed to the viscera. It also allows for minimal and targeted fixation without the use of tacks, leading to decreased postoperative pain and complications. In this article, we are detailing the rTAPP approach in managing MHs.