ABSTRACT
Introduction: Herniation through right sternocostal hiatus called Morgagni hernia [MH], constitutes about 3% of all cases of congenital diaphragmatic hernias. It is diagnosed with a lateral chest X-ray and confirmed with a barium enema or computed tomography. The defect can be repaired by a transabdominal, transthoracic approach, or via minimal invasive surgery
Case presentation: An 81-year-old female with a history of cholecystectomy presented to our center with nausea and vomiting for the last two weeks
Surgical technique: The laparoscopic repair of the MH was carried out under general anesthesia, and the patient was positioned in supine position. A segment of transverse colon with omentum, the round and the falciform ligament, the antro-pyloric region along with the first portion of the duodenum were seen herniating into the hernia sac and were easily reduced without significant adhesion to the sac. The defect was closed with non-absorbable 1-0 suture, using transfascial sutures with the knots residing in the subcutaneous plane. A polypropylene mesh of 20 x 15 cm was inserted into the abdominal cavity through 10 mm port, and fixed to the anterior abdominal wall and edge of the diaphragmatic defect with tackers
Discussion : There is no guidelines to date on the optimal surgical approach since open abdominal, open thoracic as well as minimal invasive techniques have all been practiced. In our patient we did not resect hernia sac as we judged that excision was difficult and could have led to damage to the pericardium or mediastinal structures. Closure of the edges of the hernia was done with extracorporeal knots in the subcutaneous plane and we consider the transfascial sutures to be a practical and reliable way to close the defect. Fixation of the mesh was done using tackers. We think that this technique should be the approach of choice for the treatment of MH