Department of Surgery, University of Utah, 30 North, 1900 East, Salt Lake City, UT, USA.
Surg Endosc. 2022 Jan;36(1):216-221. doi: 10.1007/s00464-020-08259-z. Epub 2021 Jan 12.
Currently, there is a relative paucity of literature regarding the management of symptomatic congenital diaphragmatic hernia of the foramen of Morgagni in the adult. This study aims to describe our unique surgical technique and outcomes in adult patients undergoing laparoscopic repair of symptomatic Morgagni hernia.
This is a retrospective review of adult patients from 2003 to 2020 who underwent a laparoscopic Morgagni hernia repair at our institution. All patients underwent a similar laparoscopic approach, utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect and mesh reinforcement with permanent mesh if the primary repair was subjectively under tension.
The study population consisted of 12 consecutive patients with a Morgagni hernia. Patients presented with a variety of symptoms attributed to the hernia, including pain 83% (n = 10), respiratory symptoms and shortness of breath 58% (7), and gastrointestinal obstruction 25% (3). Other complaints included: nausea 33% (4), reflux 50% (6), early satiety 8% (1), palpitations 16% (2), a gurgling sensation in the chest 8% (1), and weight loss 8% (1). Primary repair was possible in all patients following complete reduction of hernia contents including the hernia sac. Mesh reinforcement was used in 5 of 12 patients. Average surgical operative time was 93 (± 37) min. Median length of stay was 1.3 days (range 0.5-5.5 days). At a median follow-up of 10.9 months (IQR 8.0-41.5 months), all symptoms attributed to the hernia had resolved. No recurrences were identified.
Adults with symptomatic Morgagni hernia should undergo surgical repair. A laparoscopic approach utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect (when possible), with or without mesh reinforcement can be performed safely and effectively.
目前，成人孔源性膈疝的管理文献相对较少。本研究旨在描述我们在成人孔源性膈疝患者中采用的腹腔镜修补术的独特技术和结果。
这是一项对 2003 年至 2020 年在我院接受腹腔镜孔源性膈疝修补术的成年患者的回顾性研究。所有患者均采用相似的腹腔镜入路，采用减少腹腔内容物、完全切除疝囊、然后进行疝缺损的一期修补的手术原则，如果一期修补主观上存在张力，则使用永久性补片进行加强。
研究人群包括 12 例连续的孔源性膈疝患者。患者出现多种与疝相关的症状，包括疼痛 83%（n=10）、呼吸症状和呼吸急促 58%（7）、胃肠道梗阻 25%（3）。其他症状包括：恶心 33%（4）、反流 50%（6）、早饱 8%（1）、心悸 16%（2）、胸部咕噜声 8%（1）和体重减轻 8%（1）。在所有患者中，通过完全减少疝内容物（包括疝囊）后，均可以进行一期修补。12 例患者中有 5 例使用了补片加强。平均手术时间为 93（±37）分钟。中位住院时间为 1.3 天（范围 0.5-5.5 天）。在中位随访 10.9 个月（IQR 8.0-41.5 个月）时，所有与疝相关的症状均已缓解。未发现复发。
有症状的孔源性膈疝成人患者应行手术治疗。采用腹腔镜入路，遵循减少腹腔内容物、完全切除疝囊、然后进行疝缺损一期修补（如果可能）的手术原则，必要时可使用或不使用补片加强，可安全有效地进行。
