Abstract | March 24, 2024

Laparoscopic Morgagni Hernia Repair with Mesh: Case Report

Meghana Kumar, MD, General Surgery, PGY3, UMKC, Kansas City, MO

Sharan Mangat, BA, Medical Student, UMKC, Kansas City, MO; Stanley Augustin, MD, General Surgery and Critical Care, Surgery, UMKC, Kansas City, MO

Learning Objectives

  1. Describe what Morgagni hernias are and that it is recommended to repair them due to risk of incarceration
  2. Identify that while it is recommended to repair all Morgagni defects, there is no standard first-line approach to repair
  3. Be able to cite that similar to most hernia repairs, a tension-free repair is ideal
  4. Primary repair with mesh reinforcement theoretically is a stronger repair
  5. While there are set recommendations for when abdominal wall repairs can be closed just primarily, this is not applicable to Morgagni hernias
  6. There is no set recommended size of defect to size of mesh ratio

Introduction: A Morgagni hernia is a rare form of congenital diaphragmatic hernia that is often diagnosed in early childhood. However, the defect can go undetected in asymptomatic adults until they present with frank incarceration and strangulation of bowel contents. To prevent such life-threatening sequelae, it is proposed that all adult Morgagni hernias be surgically repaired when diagnosed, yet there is no agreed-upon standard approach to repair. Discussions have centered around whether an abdominal or thoracic approach is preferred, as well as the efficacy of open or minimally invasive methods. In this case report we discuss a laparoscopic abdominal repair with mesh reinforcement in an adult male presenting with a Morgagni hernia.

Case Presentation: This is a 25-year-old Caucasian male who presented to the emergency department multiples times in at a local primary safety-net hospital for progressively worsening abdominal pain, nausea, vomiting, constipation and bloating in 2023. He had a known history of a diaphragmatic hernia diagnosed at 18-years-old along with chronic alcohol use disorder. Had no prior surgical history. His BMI was normal and had prior EGDs revealing mild gastritis and esophagitis. CT scan of his abdomen/pelvis revealed a Morgagni hernia containing transverse colon without signs of obstruction. He was evaluated in surgery clinic and underwent a scheduled laparoscopic Morgagni hernia repair with mesh in July of 2023. During surgery, four ports were placed, a defect approximately 4x7cm was noted, chronically incarcerated colon was reduced but the sac was not completely reduced, the defect was primarily repaired with percutaneous interrupted 0-nonabsorbable braided polyester suture, and was reinforced with a 10.2×15.2cm elliptical shaped one-sided coated medium weight monofilament polypropylene mesh that was both sutured and tacked in place.

Final Diagnosis: Morgagni Hernia

Management/Follow-up: Laparoscopic Morgagni Hernia Repair with Mesh
Patient has been seen in clinic post-operatively and his symptoms have drastically improved. As the hernia sac was not resected, post-operative imaging does reveal an expected simple fluid collection near the pericardium. The hernia has not recurred.

References and Resources

  1. Oppelt PU, Askevold I, Bender F, et al. Morgagni−Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience. Hernia. 2021;25(2):479-489. doi:10.1007/s10029-020-02147-0.
  2. Sharma A, Khanna R, Panigrahy P, Meena RN, Mishra SP, Khanna S. An Incidental Finding of Morgagni Hernia in an Elderly Female and Its Successful Management: A Rare Case Report and Review of Literature. Cureus. 15(7):e42676. doi:10.7759/cureus.42676.
  3. Svetanoff WJ, Rentea RM. Morgagni Hernia. In: StatPearls. StatPearls Publishing; 2023. Accessed October 26, 2023. http://www.ncbi.nlm.nih.gov/books/NBK557501/.
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