Laparoscopic sleeve gastrectomy with concomitant Morgagni hernia repair

Abstract

A 36-year-old morbidly obese female with BMI 66 kg/m2, scheduled for elective laparoscopic sleeve gastrectomy. Prior to the surgery patient had symptoms of mild dyspnea, vague abdominal discomfort. CAT scan of thorax and abdomen revealed a right-sided large morgagni diaphragmatic hernia containing omentum and portion of the transverse colon. Patient elected to undergo Laparoscopic sleeve gastrectomy and concomitant morgagni diaphragmatic hernia repair. The post-operative course was uneventful and the patient was discharged on post-operative Day 2. This case is an extremely rare case of super obese patient with Morgagni hernia who desires bariatric surgery and found to have incidental finding of morgagni hernia. This kind of combination can safely undergo concomitant laparoscopic hernia repair with mesh and sleeve gastrectomy.

A Case Report and Literature Review on Incidental Morgagni Hernia in Bariatric Patients: To Repair or Not to Repair?

“…MHs identified by Giovanni-Battista Morgagni in 1769 are a rare type of CDH and are reported to occur in less than 2-3% of cases [ 2 , 3 , 13 ]. These retroxiphoid diaphragmatic defects are postulated to occur from an incomplete fusion of the septum transversum and sternum with the ribs anteriorly and are found to be right-sided in 90% of cases, left-sided in 8% of cases, and bilateral in 2% of identified cases [ 14 ] (Figure 1 ).…”

“…Protrusion of viscus through these foramina results in Morgagni hernias (MHs). These defects are the rarest manifestation of congenital diaphragmatic hernias (CDHs), comprising 2-3% of cases [2][3][4]. Adult patients are often asymptomatic, and these defects are often discovered incidentally during diagnostic workup or the intraoperative period [2].…”

“…These defects are the rarest manifestation of congenital diaphragmatic hernias (CDHs), comprising 2-3% of cases [2][3][4]. Adult patients are often asymptomatic, and these defects are often discovered incidentally during diagnostic workup or the intraoperative period [2]. In addition to MHs, hernia defects can also occur within the foramen of Bochdalek, which often occur along the posterolateral wall of the diaphragm [1].…”

Surgical technique of congenital diaphragmatic hernia following sleeve gastrectomy; a case report study

“…We found just a case study with same problem in which a 36-year-old morbidly obese female who wanted to undergo bariatric surgery and found to have incidental finding of morgagni hernia. The surgeons reported a safely concomitant laparoscopic hernia repair along with sleeve gastrectomy [12] . Nevertheless, it is the first time a patient was diagnosed with CDH following bariatric surgery where the patient had no respiratory and gastrointestinal symptoms.…”

Case report: Laparoscopic nissen-sleeve gastrectomy in a young adult with incidental finding of Morgagni-Larrey hernia

“…Recently a new technique consisting in LSG with associated fundoplication has been described (6). To the best of our knowledge, there are only few anecdotal cases of intraoperative finding and concomitant repair of a Morgagni-Larrey diaphragmatic hernia during a bariatric procedure (7,8).…”