Laparoscopic Robotic Repair of Bilateral Incarcerated Morgagni Hernia with Mesh: a case study

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2020

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Pineda, Jonathan

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Abstract

INTRODUCTION: Congenital diaphragmatic hernias are generally discovered and corrected in infancy. Morgagni hernias compose 2% to 4% of all diaphragmatic hernias and is typically found in the anteromedial portion of the diaphragm and on the right. These types of hernia are usually repaired via laparotomy, laparoscopically, thoracoscopy and less so using a robot-assisted laparoscopic repair. We present the case of a 29 year old female with bilateral Morgagni hernias that was successfully repaired using robot assisted laparoscopy. CASE PRESENTATION: A 29 year old female presented with a lifetime difficulty of breathing and constipation with no clear indication why. She had gone to the emergency room for a ruptured ovarian cyst, where an incidental note was made of a large right Morgagni hernia that contained a majority of her transverse colon, as well as incarcerated fat on the left. She underwent robot-assisted laparoscopic repair using the abdominal approach. While intraoperative it was found that her hernia was in fact, bilateral. The hernial contents were reduced and the defect was closed using a Parietene mesh. The patient was discharged the same day. CONCLUSIONS: Morgagni hernias are relatively rare and bilateral are even less common. The most common approach to repairing these are via laparotomy, however with the ergonomics of sitting, the added dexterity with increased range of motion of the tools, and the 3d view, and decreased length of stay after surgery, the robot should be more heavily considered for these types of surgeries.

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