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Laparoscopic repair of Morgagni diaphragmatic hernia in children. An origical technique (About 14 Cases)

Fouad Ettayebi, Houda Ouubejja, Hicham Zerhouni, Mounir Erraj

Department of Paediatric Surgery, Children’s Hospital of Rabat, Rabat, Morocco



Introduction: Morgagni diaphragmatic Hernia is an anterior midline defect of the sternal and costal parts of the diaphragm. It’s considered the rarest form of diaphragmatic hernia, accounting for only 2-3% of all defect of the diaphragm.
Aim of study: to report our experience concerning the laparoscopic treatment of Morgagni diaphragmatic Hernia.
Material and methods: We present our procedure performed in 14 patients. The mean age of our patients is 4 years. The youngest patients have 2 years old.
Results: Only two ports are used: A 10mm port for the endoscope and a 3,5 mm port in the upper left quadrant of the abdomen. A “reverdin” needle, used in classical surgery, introduced via a subxyphoid incision (5mm) allow to charge the posterior edge of the diaphragmatic defect and to perform extracorporeal sutures. No attempt was made to remove the sac in order to avoid injuries of the mediastinum. The mean operative time is 30 mm. Patients were discharged in 48 H. One recurrence of the Hernia have been found and managed by laparoscopy. The mean follow up is about 8 years.
Discussion-conclusion: Morgagni diaphragmatic Hernia is usually asymptomatic and often discovered on incidental chest radiography. Most surgeon recommend surgical repair even in asymptomatic patients because of the risk of strangulation, gastric volvulus or cardiac tamponade. The repair of the defect can be safely and easily performed by a laparoscopic approach.