Laparoscopic-assisted Versus Open Repair of Morgagni Hernia in Infants and Children

Background: Morgagni hernia is rare and represents less than 5% of all congenital diaphragmatic hernias. The defect is repaired either by conventional open surgery or laparoscopically. The aim of this study was to compare the conventional open technique with the laparoscopic-assisted repair of Morgagni hernia. Patients and Methods: The medical records of all infants and children with the diagnosis of Morgagni hernia were retrospectively reviewed and divided into 2 groups according to the method of repair, the laparoscopic-assisted group and the open surgery group. The 2 groups were compared according to the operative time, hospital stay, time to commencement of full feeds, requirement for postoperative analgesia, complications, and outcome. Results: Twenty-three (16 male and 7 female) patients had open surgery repair. Their age ranged from 1 to 60 months (median 9 mo). Nine patients had right-sided, 5 had left-sided hernia, and 9 (39%) had bilateral hernias. Associated anomalies were seen in 18 patients (78.3%). Eight patients (34.8%) had congenital heart disease, 5 (21.7%) had malrotation of bowel, and 6 (26%) had Down syndrome. All were operated transabdominally (14 upper midline and 8 upper transverse) except for 1 patient who had a right thoracotomy. In all patients, there was a hernia sac that was excised and the defect was repaired using nonabsorbable sutures. On follow-up, 2 patients (8.7%) developed recurrence. Sixteen patients (10 boys and 6 girls) had laparoscopic-assisted repair of Morgagni hernia. Their age ranged from 8 to 42 months (median 18.5 mo). Only 1 patient had Down syndrome and congenital heart disease. Seven patients had right-sided hernia, 7 had left-sided hernia, and 2 had bilateral hernia. On follow-up, 1 patient had a small residual sac 6 months postoperatively, without clinical significance. When the 2 groups were compared, the laparoscopic-assisted group was better in terms of shorter operative time, shorter time to commencement of full feeds, less postoperative analgesia, shorter hospital stay, and better cosmetic results. Conclusions: Laparoscopic-assisted repair of Morgagni hernia is an excellent and simple alternative to open surgery. It is, however, superior over conventional open surgery and the benefits are shorter operative time, early commencement of full feeds, less postoperative analgesia, rapid recovery, shorter hospital stay, and better cosmetic results. Laparoscopic-assisted repair of Morgagni hernia should be considered as the procedure of choice for the treatment of Morgagni hernia in infants and children. Leaving the hernia sac plicated in place has no adverse effects.