Morgagni hernia repair in adult obese patient by hybrid robotic thoracic surgery

Abstract

Morgagni hernia is a relatively uncommon congenital diaphragmatic hernia in which abdominal contents protrude into the chest through the foramen of Morgagni. It usually occurs on the right side of the chest but may occur on the left side or in the midline. In adults, it commonly presents with non-specific symptoms such as dyspnea, cough, gastroesophageal reflux disease and other. Surgical repair should be always performed to prevent the risk of hernia incarceration. Transthoracic approach has been proposed especially in cases with indeterminate, anterior pericardial masses. We believe that in adult obese patients with Morgagni hernia and voluminous hernial sac containing only omentum, the transthoracic approach can represent a valid alternative to transabdominal approach. The use of hybrid robotic thoracic surgery can be strongly recommended because it allows, through robotic instruments, to perform delicate surgical maneuvers in difficult to reach anatomical areas and, with the final extension of a port-site incision, to remove voluminous specimens from the thoracic cavity, avoiding the chest wall discomfort that follow the thoracotomy access.

Larrey diaphragmatic hernia in an adult

“…The well-known advantages of the minimally invasive treatment, including the faster postoperative recovery, as well as the shorter hospitalization period and minimal scarring, urged an increased number of surgeons to treat the patients in this manner in the last several years [1,14]. The robotic surgery, whether transabdominal or transthoracic, represents another technological progress with well-recognized advantages: ergonomics, preciseness of instruments, as well as easy operation in narrow spaces [15,16]. With regard to the treatment with a small-diameter hernia opening (less than 16 cm 2 ), it is possible to perform a primary suture, while in larger defects (larger than 20-30 cm 2 ), the plastics of the diaphragm opening is induced with the help of various kinds of meshes, to avoid tension [14].…”

Rapid evolution of a Morgagni hernia with herniation of the left hepatic lobe: case report and review of the literature

“…Open, minimally invasive and robotic-assisted repairs have been described for both trans -abdominal [ 1–5 ] and trans -thoracic approaches [ 6 ]. There is only a recent case report suggesting viability of the robotic platform being used in the setting of acute presentation [ 5 ].…”

Robotic Repair of Morgagni Hernia in Adult Patient

“…Pulmonary symptoms may include shortness of breath or recurrent pneumonia. Gastrointestinal symptoms include gastroesophageal reflux, dysphagia, regurgitation, or obstruction (1)(2)(3) . These symptoms usually lead to diagnostic workup, including cross-sectional imaging, leading to elective repair.…”

“…The rarity of the diagnosis makes it difficult to standardize recommendations for the method of repair. Recently, this rare condition has been treated with a robotic-assisted procedure (1)(2)(3)(4)(5)(6) . This video demonstrates a robotic repair of a Morgagni hernia in an adult.…”