Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2019 Jan;107(1):257-261. doi: 10.1016/j.athoracsur.2018.08.021. Epub 2018 Oct 6.
Morgagni hernias are rare congenital diaphragmatic hernias that often do not become clinically significant until adulthood. The purpose of this study was to characterize the preoperative findings and describe surgical outcomes of Morgagni hernia repair based on operative approach.
Charts of patients who underwent repair of a Morgagni hernia were retrospectively reviewed from 1987 to 2015. Medical records were reviewed for demographics, symptoms, comorbidities, surgical approach, hospital course, complications, and preoperative imaging.
Forty-three cases were identified, 23 male and 20 female. Median age was 50.4 years, and median body mass index was 33.1 kg/m. Most common presenting symptoms were respiratory (35.7%) and gastrointestinal (28.6%). Although 83.3% of cases were newly diagnosed, none required emergent repair. Preoperative imaging demonstrated an average hernia size of 8.2 cm. Surgical approaches included laparotomy (62.8%), laparoscopic (23.3%), and thoracotomy (14%). Primary hernia repair was most common (72%). Comparing laparotomy, thoracotomy, and laparoscopic approaches, mesh repair was more common with laparoscopy (p = 0.005), operative time was shortest with laparotomy (p = 0.029), and hospital length of stay was shortest with laparoscopy (p = 0.024). The most common complication was incisional/port site hernia, with no statistical significance between surgical approaches. There was one Morgagni hernia recurrence.
Morgagni hernias often present with respiratory and gastrointestinal symptoms and require repair. All cases in our series were repaired electively. Regardless of approach recurrence rate was low (2.3%) and complication rate was similar between laparoscopic, laparotomy, and thoracotomy. Given the shorter length of stay with similar recurrence rates, a laparoscopic approach is a viable option for repair of Morgagni hernia.
Morgagni 疝是一种罕见的先天性膈疝，通常在成年后才变得具有临床意义。本研究的目的是描述 Morgagni 疝修补术的术前发现，并根据手术入路来描述手术结果。
回顾性分析了 1987 年至 2015 年期间接受 Morgagni 疝修补术的患者的病历。对患者的人口统计学资料、症状、合并症、手术入路、住院过程、并发症和术前影像学资料进行了回顾。
共确定了 43 例病例，其中男 23 例，女 20 例。中位年龄为 50.4 岁，中位体重指数为 33.1kg/m。最常见的首发症状为呼吸系统（35.7%）和消化系统（28.6%）。尽管 83.3%的病例为新诊断，但均无需紧急修复。术前影像学检查显示疝的平均大小为 8.2cm。手术入路包括开腹（62.8%）、腹腔镜（23.3%）和胸腔镜（14%）。最常见的手术方式为原发性疝修补术（72%）。与开腹、胸腔镜和腹腔镜相比，腹腔镜手术中更常见使用补片修复（p=0.005），开腹手术的手术时间最短（p=0.029），腹腔镜手术的住院时间最短（p=0.024）。最常见的并发症是切口/端口疝，不同手术入路之间无统计学差异。有 1 例 Morgagni 疝复发。
Morgagni 疝常表现为呼吸系统和消化系统症状，需要进行修补。我们研究中的所有病例均为择期修补。无论采用哪种手术入路，复发率均较低（2.3%），腹腔镜、开腹和胸腔镜手术的并发症发生率相似。鉴于腹腔镜手术的住院时间较短，且复发率相似，因此腹腔镜手术是修补 Morgagni 疝的可行选择。
