Recurrence rate of Morgagni diaphragmatic hernia following laparoscopic repair
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ORIGINAL ARTICLE
Recurrence rate of Morgagni diaphragmatic hernia following laparoscopic repair Massimo Garriboli • Mark Bishay • Edward M. Kiely • David P. Drake • Joseph I. Curry • Kate M. K. Cross • Simon Eaton • Paolo De Coppi • Agostino Pierro
Published online: 13 November 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose Morgagni diaphragmatic hernia can be repaired laparoscopically. The aim of this study is to evaluate the outcome of this minimally invasive approach. Methods A retrospective review was conducted on all consecutive children who underwent repair of Morgagni hernia from January 2002 to December 2011 in our hospital. Data are expressed as median (range). Results There were 12 children with Morgagni hernia. Age at surgery was 7.5 months (2–125). Associated malformations were present in 7 children (58 %). All children underwent initial laparoscopic approach. Two children (16 %) underwent conversion to open surgery. The hernia was closed primarily in 11 children (92 %), using a polyester patch in 1 (8 %). There were no intraoperative or immediate postoperative complications. Five children (42 %), all repaired initially without a patch, had a recurrence of the Morgagni hernia. The repair of the recurrent hernia was performed laparoscopically in four out of the five children, and a patch was used in two patients with no further recurrences or complications. Conclusions There is a high rate of recurrence after laparoscopic Morgagni hernia repair. This is exclusively associated with laparoscopic repair without patch, and it is in contrast with the low recurrence rate reported previously. More frequent use of patch may be beneficial.
Keywords Morgagni hernia Congenital diaphragmatic hernia Laparoscopy Children Paediatric surgery Minimally invasive surgery
Introduction Morgagni hernia is a rare congenital herniation of abdominal organs into the thorax through an anteromedial diaphragmatic defect. The Italian anatomist Giovanni Morgagni first described the eponymous foramen in 1769 [1]. Foramen of Morgagni hernia occurs in one in 4,800 live births and represents 2 % of congenital diaphragmatic hernia. Morgagni hernia usually differs from the more common posterolateral Bochdalek hernia in presenting later, and having a higher incidence of bilaterality and little or no association with pulmonary hypoplasia. Hernia contents may typically include the omentum, colon and small bowel. The standard approach for the repair has been through a laparotomy, or more rarely via thoracotomy, but recently it has been demonstrated that Morgagni hernias can be repaired laparoscopically [2, 3]. The aim of this study was to evaluate the outcome of this minimally invasive repair of Morgagni hernia in our institution.
Methods
M. Garriboli M. Bishay E. M. Kiely D. P. Drake J. I. Curry K. M. K. Cross S. Eaton P. De Coppi A. Pierro (&) Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London WC1N 1EH, UK e-mail: [email protected].
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