Puglisi Francesco, Capuano Palma, Iambrenghi Onofrio Caputi, Armenise Nicola, Carlucci Francesco, Memeo Maurizio, Memeo Riccardo, Martines Gennaro
General Surgery Unit, Department of Emergency and Organ Transplantation, University of Bari.
Chir Ital. 2009 May-Jun;61(3):351-6.
Morgagni hernia is a rare cause of diaphragmatic hernia. There are few reports of laparoscopic repair in the literature. Tension-free hernia closure with synthetic mesh reduces recurrence but occasionally results in complications, such as visceral stricture, erosion or perforation. We report a case of successful laparoscopic repair of a very large symptomatic Morgagni hernia in a 78-year-old patient, treated by positioning a gradually resorbable mesh made from porcine SIS (Surgisis Soft Tissue Graft device--Cook Inc, Bloomington, Ind). After surgery, the patient reported an immediate, marked improvement in clinical symptoms. During the postoperative course, pleural and pericardial leakage occurred. The pleural leakage was immediately drained with thoracentesis, and the pericardial leakage was treated conservatively. No other complications occurred after patient discharge. One year later, the patient was in very good general condition. No recurrence was documented with abdominal CT scan, which also demonstrated connective tissue proliferation that was progressively replacing the prosthesis. Laparoscopic repair is a safe, efficacious procedure for the treatment of diaphragmatic hernia, and presents all the advantages of minimally invasive surgery. The use of new types of material featuring marked biocompatibility and gradual reabsorbability characteristics offers considerable benefits.
莫尔加尼疝是膈疝的一种罕见病因。文献中关于腹腔镜修补术的报道较少。使用合成补片进行无张力疝修补可降低复发率，但偶尔会导致并发症，如内脏狭窄、侵蚀或穿孔。我们报告了一例78岁有症状的巨大莫尔加尼疝患者成功接受腹腔镜修补术的病例，术中使用了由猪小肠黏膜下层制成的可逐渐吸收的补片（Surgisis软组织移植装置——库克公司，印第安纳州布卢明顿）。术后，患者报告临床症状立即有明显改善。术后过程中，出现了胸膜和心包渗漏。胸膜渗漏通过胸腔穿刺立即引流，心包渗漏采用保守治疗。患者出院后未发生其他并发症。一年后，患者总体状况良好。腹部CT扫描未发现复发，且显示结缔组织增生正在逐渐替代补片。腹腔镜修补术是治疗膈疝的一种安全、有效的方法，具有微创手术的所有优点。使用具有显著生物相容性和逐渐吸收特性的新型材料有诸多益处。
