Comparison of Laparoscopic Versus Open Surgical Management of Morgagni Hernia

Michael C. Young, Sahar A. Saddoughi, Johnathon M. Aho, William S. Harmsen, Mark S. Allen, Shanda H. Blackmon, Stephen D. Cassivi, Francis C. Nichols, K. Robert Shen, Dennis A Wigle

Research output: Contribution to journalArticle

Abstract

Background: Morgagni hernias are rare congenital diaphragmatic hernias that often do not become clinically significant until adulthood. The purpose of this study was to characterize the preoperative findings and describe surgical outcomes of Morgagni hernia repair based on operative approach. Methods: Charts of patients who underwent repair of a Morgagni hernia were retrospectively reviewed from 1987 to 2015. Medical records were reviewed for demographics, symptoms, comorbidities, surgical approach, hospital course, complications, and preoperative imaging. Results: Forty-three cases were identified, 23 male and 20 female. Median age was 50.4 years, and median body mass index was 33.1 kg/m2. Most common presenting symptoms were respiratory (35.7%) and gastrointestinal (28.6%). Although 83.3% of cases were newly diagnosed, none required emergent repair. Preoperative imaging demonstrated an average hernia size of 8.2 cm. Surgical approaches included laparotomy (62.8%), laparoscopic (23.3%), and thoracotomy (14%). Primary hernia repair was most common (72%). Comparing laparotomy, thoracotomy, and laparoscopic approaches, mesh repair was more common with laparoscopy (p = 0.005), operative time was shortest with laparotomy (p = 0.029), and hospital length of stay was shortest with laparoscopy (p = 0.024). The most common complication was incisional/port site hernia, with no statistical significance between surgical approaches. There was one Morgagni hernia recurrence. Conclusions: Morgagni hernias often present with respiratory and gastrointestinal symptoms and require repair. All cases in our series were repaired electively. Regardless of approach recurrence rate was low (2.3%) and complication rate was similar between laparoscopic, laparotomy, and thoracotomy. Given the shorter length of stay with similar recurrence rates, a laparoscopic approach is a viable option for repair of Morgagni hernia.

Original languageEnglish (US)
Pages (from-to)257-261
Number of pages5
JournalAnnals of Thoracic Surgery
Volume107
Issue number1
DOIs
StatePublished - Jan 1 2019

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Laparotomy
Thoracotomy
Length of Stay
Herniorrhaphy
Hernia
Recurrence
Laparoscopy
Operative Time
Congenital Diaphragmatic Hernias
Medical Records
Comorbidity
Body Mass Index
Demography

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Young, M. C., Saddoughi, S. A., Aho, J. M., Harmsen, W. S., Allen, M. S., Blackmon, S. H., ... Wigle, D. A. (2019). Comparison of Laparoscopic Versus Open Surgical Management of Morgagni Hernia. Annals of Thoracic Surgery, 107(1), 257-261. https://doi.org/10.1016/j.athoracsur.2018.08.021

Comparison of Laparoscopic Versus Open Surgical Management of Morgagni Hernia. / Young, Michael C.; Saddoughi, Sahar A.; Aho, Johnathon M.; Harmsen, William S.; Allen, Mark S.; Blackmon, Shanda H.; Cassivi, Stephen D.; Nichols, Francis C.; Shen, K. Robert; Wigle, Dennis A.

In: Annals of Thoracic Surgery, Vol. 107, No. 1, 01.01.2019, p. 257-261.

Research output: Contribution to journalArticle

Young, MC, Saddoughi, SA, Aho, JM, Harmsen, WS, Allen, MS, Blackmon, SH, Cassivi, SD, Nichols, FC, Shen, KR & Wigle, DA 2019, 'Comparison of Laparoscopic Versus Open Surgical Management of Morgagni Hernia', Annals of Thoracic Surgery, vol. 107, no. 1, pp. 257-261. https://doi.org/10.1016/j.athoracsur.2018.08.021
Young MC, Saddoughi SA, Aho JM, Harmsen WS, Allen MS, Blackmon SH et al. Comparison of Laparoscopic Versus Open Surgical Management of Morgagni Hernia. Annals of Thoracic Surgery. 2019 Jan 1;107(1):257-261. https://doi.org/10.1016/j.athoracsur.2018.08.021
Young, Michael C. ; Saddoughi, Sahar A. ; Aho, Johnathon M. ; Harmsen, William S. ; Allen, Mark S. ; Blackmon, Shanda H. ; Cassivi, Stephen D. ; Nichols, Francis C. ; Shen, K. Robert ; Wigle, Dennis A. / Comparison of Laparoscopic Versus Open Surgical Management of Morgagni Hernia. In: Annals of Thoracic Surgery. 2019 ; Vol. 107, No. 1. pp. 257-261.
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abstract = "Background: Morgagni hernias are rare congenital diaphragmatic hernias that often do not become clinically significant until adulthood. The purpose of this study was to characterize the preoperative findings and describe surgical outcomes of Morgagni hernia repair based on operative approach. Methods: Charts of patients who underwent repair of a Morgagni hernia were retrospectively reviewed from 1987 to 2015. Medical records were reviewed for demographics, symptoms, comorbidities, surgical approach, hospital course, complications, and preoperative imaging. Results: Forty-three cases were identified, 23 male and 20 female. Median age was 50.4 years, and median body mass index was 33.1 kg/m2. Most common presenting symptoms were respiratory (35.7{\%}) and gastrointestinal (28.6{\%}). Although 83.3{\%} of cases were newly diagnosed, none required emergent repair. Preoperative imaging demonstrated an average hernia size of 8.2 cm. Surgical approaches included laparotomy (62.8{\%}), laparoscopic (23.3{\%}), and thoracotomy (14{\%}). Primary hernia repair was most common (72{\%}). Comparing laparotomy, thoracotomy, and laparoscopic approaches, mesh repair was more common with laparoscopy (p = 0.005), operative time was shortest with laparotomy (p = 0.029), and hospital length of stay was shortest with laparoscopy (p = 0.024). The most common complication was incisional/port site hernia, with no statistical significance between surgical approaches. There was one Morgagni hernia recurrence. Conclusions: Morgagni hernias often present with respiratory and gastrointestinal symptoms and require repair. All cases in our series were repaired electively. Regardless of approach recurrence rate was low (2.3{\%}) and complication rate was similar between laparoscopic, laparotomy, and thoracotomy. Given the shorter length of stay with similar recurrence rates, a laparoscopic approach is a viable option for repair of Morgagni hernia.",
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AU - Saddoughi, Sahar A.

AU - Aho, Johnathon M.

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AU - Allen, Mark S.

AU - Blackmon, Shanda H.

AU - Cassivi, Stephen D.

AU - Nichols, Francis C.

AU - Shen, K. Robert

AU - Wigle, Dennis A

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N2 - Background: Morgagni hernias are rare congenital diaphragmatic hernias that often do not become clinically significant until adulthood. The purpose of this study was to characterize the preoperative findings and describe surgical outcomes of Morgagni hernia repair based on operative approach. Methods: Charts of patients who underwent repair of a Morgagni hernia were retrospectively reviewed from 1987 to 2015. Medical records were reviewed for demographics, symptoms, comorbidities, surgical approach, hospital course, complications, and preoperative imaging. Results: Forty-three cases were identified, 23 male and 20 female. Median age was 50.4 years, and median body mass index was 33.1 kg/m2. Most common presenting symptoms were respiratory (35.7%) and gastrointestinal (28.6%). Although 83.3% of cases were newly diagnosed, none required emergent repair. Preoperative imaging demonstrated an average hernia size of 8.2 cm. Surgical approaches included laparotomy (62.8%), laparoscopic (23.3%), and thoracotomy (14%). Primary hernia repair was most common (72%). Comparing laparotomy, thoracotomy, and laparoscopic approaches, mesh repair was more common with laparoscopy (p = 0.005), operative time was shortest with laparotomy (p = 0.029), and hospital length of stay was shortest with laparoscopy (p = 0.024). The most common complication was incisional/port site hernia, with no statistical significance between surgical approaches. There was one Morgagni hernia recurrence. Conclusions: Morgagni hernias often present with respiratory and gastrointestinal symptoms and require repair. All cases in our series were repaired electively. Regardless of approach recurrence rate was low (2.3%) and complication rate was similar between laparoscopic, laparotomy, and thoracotomy. Given the shorter length of stay with similar recurrence rates, a laparoscopic approach is a viable option for repair of Morgagni hernia.

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