Contributors: Anahita Jalilvand and Marco P. Fisichella
This video describes a laparoscopic-extracorporeal repair with mesh of a Morgagni diaphragmatic hernia in an 81 year old female.
We used Ventralight™ ST Mesh which is an uncoated lightweight monofilament polypropylene mesh on the anterior side with an absorbable hydrogel barrier based on Sepra® Technology on the posterior side for laparoscopic ventral hernia repair. The posterior side mesh does not cause adhesion with the abdominal organs.
A quick review of the literature of laparoscopic cases has shown that in a substantial amount of cases the hernia was reduced and the defect repaired with mesh placement without hernia sac resection . Therefore, non-resecting the sac is an acceptable option.
This choice of operative approach was based on an article co-authored in 2001 by the housestaff involved in this patient care, which detailed a simpler method of surgically managing Morgagni diaphragmatic hernias. An overview of the procedure is diagrammatically shown in the video.
Since the patient was symptomatic from her hernia, surgical repair was indicated.
There were no contraindications in this patient
The operative planning and the key steps of the procedure are featured, including the patient's initial positioning in steep reverse Trendelenberg that facilitated the hernia reduction; port sites placement; reduction of the hernia; dissection of the falciform ligament to provide a tension free repair; extracorporeal repair of the Morgagni defect; and mesh placement in an underlay fashion underneath the costal margins.
Abdominal and chest CT with contrast helped diagnose the right parasternal, anterolateral position of Morgagni diaphragmatic hernias.
La Greca G, Fisichella PM, Greco L, Di Stefano A, Rossello D, Latteri F. A new simple laparoscopic-extracorporeal technique for the repair of a Morgagni diaphragmatic hernia. Surg Endosc. 2001;15(1):99