Abstract
Purpose: We report our preliminary experience with laparoscopic repair of anterior midline (Morgagni) diaphragmatic hernia and identify technical issues.
Methods: Four consecutive children undergoing laparoscopic Morgagni hernia repair over 3 years were reviewed.
Results: The ages ranged from 13 months to 13 years. Three were found incidentally, and one presented with sudden onset of left side chest pain; none had obstructive symptoms. At operation the hernia contained omentum in all cases and bowel in three cases. All four underwent primary laparoscopic repair with interrupted nonabsorbable sutures. A small residual eventration was left along the edge of the pericardium in the one patient with a sac. The patient who presented with chest pain was found grossly and histologically to have acute appendicitis within the left chest, requiring dissection of the inflamed viscera from the mediastinum and chest wall; laparoscopic appendectomy was also done. Median time to full diet was 3 days, morphine was given for a median of 36 hours, and median postoperative hospital stay was 4.5 days. There were no complications, and no cases were converted. Followup chest radiograph demonstrated complete resolution of the hernia in three patients, and a small amount of residual bowel in the unrepaired pericardial portion of the eventration in the other patient. All children remain clinically well.
Conclusion: Laparoscopic repair of Morgagni diaphragmatic hernia in children is a safe technique that provides rapid recovery and superior cosmetic results. Many unexpected technical challenges can be managed effectively without converting to an open approach.
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