Introduction
Materials and methods
Patients and study design
Surgical technique
Literature review
Results
Variables | All patients (n = 11) | Subgroup analysis | |||||
---|---|---|---|---|---|---|---|
Hernia specific | Procedure specific | ||||||
Right-sided Morgagni hernia (n = 4) | Left-sided Morgagni hernia (n = 7) | p value | Open surgery (n = 4) | Laparoscopic surgery (n = 7) | p value | ||
Male gender | 10 (90.9%) | 4 (100%) | 6 (85.7%) | 1 | 4 (100%) | 6 (85.7%) | 1 |
Age (years) | 53 (19–68) | 50 (37–68) | 53 (19–66) | 0.85 | 43 (37–68) | 60 (19–66) | 0.93 |
BMI (kg/m2) | 28.7 (20.1–37.0) | 32.1 (27.7–37.0) | 24.7 (20.1–32.7) | 0.11 | 31.1 (27.7–34.7) | 24.7 (20.1–37.0) | 0.23 |
Open surgery Laparoscopic surgery | − − | 3 (75%) 1 (25%) | 1 (14.3%) 6 (85.7%) | − − | − − | − − | − − |
Chronic diseases Cardiac Pulmonal Renal | 9 (81.8%) 7 (63.6) 4 (36.4%) 2 (18.2%) | 4 (100%) 3 (75%) 1 (25%) 1(25%) | 5 (71.4%) 4 (57.1%) 3 (42.9%) 1 (14.3%) | 0.49 1 1 1 | 4 (100%) 3 (75%) 1 (25%) 0 | 5 (71.4%) 4 (57.1%) 3 (42.9%) 2 (28.6%) | 0.49 1 1 0.49 |
Symptoms | |||||||
None Dyspnea Gastrointestinala Postprandial abdominal discomfort | 3 (27.3%) 5 (45.5%) 5 (45.5%) 3 (27.3%) | 0 3 (75%) 1 (25%) 0 | 3 (42.9%) 2 (28.6%) 4 (57.1%) 3 (42.9%) | 0.24 0.24 0.55 0.24 | 0 3 (75%) 2 (50%) 3 (75%) | 3 (42.9%) 2 (28.6%) 3 (42.9%) 3 (42.9%) | 0.24 0.24 1 0.55 |
Contents of the hernia | |||||||
Stomach Colon transversum Small intestine Liver Spleen Omentum majus | 3 (27.3%) 7 (63.6%) 2 (18.2%) 1 (9.1%) 1 (9.1%) 5 (45.5%) | 0 3 (75%) 0 1 (25%) 0 3 (75%) | 3 (42.9%) 4 (51.1%) 2 (28.6%) 0 1 (14.3%) 2 (28.6%) | 0.24 1 0.49 0.36 1 0.24 | 1 (25%) 3 (75%) 0 1 (25%) 0 1 (25%) | 2 (28.6%) 4 (51.1%) 2 (28.6%) 0 1 (14.3%) 4 (51.1%) | 1 1 0.49 0.36 1 0.55 |
Variables | All patients (n = 11) | Subgroup analysis | |||||
---|---|---|---|---|---|---|---|
Hernia specific | Procedure specific | ||||||
Right-sided Morgagni hernia (n = 4) | Left-sided Morgagni hernia (n = 7) | p value | Open surgery (n = 4) | Laparoscopic surgery (n = 7) | p value | ||
Operation duration (min) | 109 (90–229) | 101.5 (90–229) | 120 (105–201) | 0.32 | 106.5 (97–229) | 120 (90–201) | 0.79 |
Mesh size (cm2)a | 300 (66–1050) | 300 (150–600) | 300 (66–1050) | 1 | 600 (300–1050) | 225 (66–560) | 0.0878 |
Postoperative in-hospital stay (days) | |||||||
ICU Total | 1 (0–6) 7 (3–23) | 2 (0–3) 7.5 (4–16) | 1 (0–6) 7 (3–23) | 0.49 0.85 | 2 (1–3) 8 (7–16) | 0 (0–6) 6 (3–23) | 0.15 0.25 |
Postoperative complications | |||||||
n patients n complications | 6 (54.5%) 9 | 2 (50%) 3 | 4 (57.1%) 6 | 1 − | 2 (50%) 3 | 4 (57.1%) 6 | 1 − |
Postoperative complicationsb [median (range)] | 3 (1–3)c | 2 (1–3) | 3 (1–3) | − | 2 (1–3) | 3 (1–3) | − |
Grade I Grade II Grade IIIa | 3 1 4 | 2 0 1d | 1 1 3e | − | 2 0 1d | 1 1 3e | − |
Variables | All patients (n = 11) | Subgroup analysis | |||||
---|---|---|---|---|---|---|---|
Hernia specific | Procedure specific | ||||||
Right-sided Morgagni hernia (n = 4) | Left-sided Morgagni hernia (n = 7) | p value | Open surgery (n = 4) | Laparoscopic surgery (n = 7) | p value | ||
Perioperative leucocytes (giga/l) | |||||||
Preoperative POD 1 POD 2 POD 3 POD 4 | 7.6 (4.8–9.8) 11.6 (5.9–22.6) 10.0 (5.1–17.3) 8.5 (4.1–13.9) 9.1 (6.4–16.0) | 9.3 (8.1–9.8) 12.9 (9.3–22.6) 15.1 (10.0–17.3) 10.2 (9.7–13.9) 9.7 (9.2–16.0) | 5.8 (4.8–8.2) 7.9 (5.9–14.3) 8.2 (5.1–11.1) 7.4 (4.1–9.4) 8.6 (6.4–10.3) | 0.01 0.16 0.02 0.006 0.14 | 8.7 (8.1–9.8) 14.1 (11.9–22.6) 15.1 (10.7–17.3) 10.0 (8.5–13.9) 9.5 (8.6–16.0) | 5.8 (4.8–9.4) 7.9 (5.9–13.1) 8.2 (5.1–11.1) 7.4 (4.1–10.0) 7.8 (6.4–10.3) | 0.04 0.01 0.01 0.04 0.34 |
Perioperative CRP (mg/l) | |||||||
Preoperative POD 1 POD 2 POD 3 POD 4 | 2.0 (0.5–18.6) 39.8 (0.6–202.1) 90.6 (20.5–206.3) 93.3 (0.6–214.2) 97.1 (1.0–145.4) | 7.8 (1.2–18.6) 48.5 (37.2–55.1) 125.8 (47.7–206.3) 136.0 (51.6–214.2) 126.2 (114.7–145.4) | 1.0 (0.5–10.3) 38.8 (0.6–202.1) 90.6 (20.5–154.1) 88.3 (0.6–151.4) 70.1 (1.0–122.7) | 0.11 0.53 0.53 0.16 0.07 | 5.2 (1.2–18.6) 51.9 (48.2–69.8) 152.2 (90.2–206.3) 136.0 (25.7–214.2) 120.4 (1.0–145.4) | 1.0 (0.5–10.3) 37.2 (0.6–202.1) 80.7 (20.0–154.1) 88.3 (0.6–151.4) 74.8 (35.8–122.7) | 0.23 0.07 0.11 0.23 0.49 |
Discussion
Authors | Reference | Publication year | Study information/observational period | n patients | Type of hernia included | Surgical techniquea |
---|---|---|---|---|---|---|
Young et al. [1] | Comparison of laparoscopic versus open surgical management of Morgagni hernia | 2019 | Retrospective, 1987–2015 | 43 | MLH | Laparotomy: n = 27 Laparoscopy: n = 10 Thoracotomy: n = 6 Suture: n = 31 Suture + mesh: n/a Mesh: n = 12 Hernia sac resection: n/a |
Agalar et al. [21] | Adult Morgagni hernia: a single-center experience of five cases and a review of literature | 2018 | Retrospective, 2009–2015 | 5 | MLH | Laparotomy: n = 2 Laparoscopy: n = 3 Suture: n = 4 Suture + mesh: n = 0 Mesh: n = 1 Hernia sac resection: n = 0 |
Târcoveanuet al. [24] | Laparoscopic management in Morgagni hernia—short series and review of literature | 2018 | Retrospective, 2011–2017 | 6 of 8 patients underwent surgery | MLH | Laparotomy: n = 2 Laparoscopy: n = 4 Suture: n = 4 Suture + mesh: n = 0 Mesh: n = 2 Hernia sac resection: n = 4 |
Arikan et al. [5] | Morgagni’s hernia: analysis of 21 patients with our clinical experience in diagnosis and treatment | 2017 | Retrospective, 2003–2015 | 21 | MLH | Laparotomy: n = 9 Laparoscopy: n = 12 Suture: n = 4 Suture + mesh: n = 6 Mesh: n = 11 Hernia sac resection: n = 17 |
Ohtsuka and Suzuki [10] | Right-sided Bochdalek hernia in an elderly patient: a case review of adult Bochdalek hernias from 1982 to 2015 in Japan | 2017 | Literature review, 1982–2015 | 109 | Bochdalek | Trans-abdominal: n = 62 (by laparoscopy: n = 12) Trans-thoracic: n = 19 (by thoracoscopy: n = 6) Thoraco-abdominal: n = 16 Suture: n = 73 Suture + mesh: n/a Mesh: n = 23 Hernia sac resection: n/a |
Saroj et al. [25] | Laparoscopic repair of congenital diaphragmatic hernia in adults | 2016 | Retrospective, 2011–2014 | 13b | Bochdalek and MLH | Laparotomy: n = 1 Laparoscopy: n = 10 Suture: n = 0 Suture + mesh: n = 10 Mesh: n = 3 Hernia sac resection: n/a, but usually performed |
Aydin et al. [26] | Morgagni hernia: transabdominal or transthoracic approach? | 2014 | Retrospective, 1997–2011 | 20 | MLH | Laparotomy: n = 14 Thoracotomy: n = 6 Suture: n = 19 Suture + mesh: n = 0 Mesh: n = 1 Hernia sac resection: n = 20 |
Park and Doyle [22] | Laparoscopic Morgagni hernia repair: how-I-do-it | 2014 | Retrospective, from 2002 | 13 | MLH | Laparoscopy: n = 13 Suture: n = 13 Suture + mesh: n = 0 Mesh: n = 0 Hernia sac resection: n/a, but is recommended |
Abraham et al. [6] | Morgagni−Larrey hernia—a review of 20 cases | 2012 | Retrospective, 1997–2010 | 20c | MLH | Trans-abdominal surgery Laparotomy: n/a Laparoscopy: n/a Suture: n = 10 Suture + mesh: n = 4 Mesh: n = 6 Hernia sac resection: n/a |
Aghajanzadeh et al. [20] | Clinical presentation and operative repair of Morgagni hernia | 2012 | Retrospective, 1996–2010 | 36 | MLH | Laparotomy: n = 26 Thoracotomy: n = 6 Thoraco-abdominal: n = 4 Suture: n = 36 Suture + mesh: n = 0 Mesh: n = 0 Hernia sac resection: n = 0 |
Gedik et al. [27] | A review of Morgagni and Bochdalek hernias in adults | 2011 | Retrospective, 2000–2010 | 20 | Bochdalek and MLH | Laparotomy: n = 19 Thoraco-abdominal: n = 1 Suture: n = 13 Suture + mesh: n = 1 Mesh: n = 6 Hernia sac resection: n/a |
Altinkaya et al. [28] | Morgagni hernia: diagnosis with multidetector computed tomography and treatment | 2009 | Retrospective, 2004–2009 | 6 of 12 patients underwent surgery | MLH | Laparotomy: n = 3 Laparoscopy: n = 2 Thoracotomy: n = 1 Suture: n = 5 Suture + mesh: n = 0 Mesh: n = 1 Hernia sac resection: n = 0 |
Palanivelu et al. [29] | Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study | 2009 | Retrospective, 1995–2007 | 21d | Bochdalek and MLH | Laparoscopy: n = 21 Suture: n = 3 Suture + mesh: n = 18 Mesh: n = 0 Hernia sac resection: n = 4 |
Horton et al. [4] | Presentation and management of Morgagni hernias in adults: a review of 298 cases | 2007 | Literature review, 1951–2006 | 298 | MLH | Laparotomy: n = 30% Laparoscopy: n = 17% Thoracotomy: n = 49% Thoracoscopy: n = 0.7% Suture: n = 29% Suture + mesh: n = 7% Mesh: n = 64% Hernia sac resection: 75.2% |
Yilmaz et al. [30] | Transabdominal approach in the surgical management of Morgagni Hernia | 2007 | Retrospective, 1999–2005 | 11 | MLH | Laparotomy: n = 11 Suture: n = 10 Suture + mesh: n = 0 Mesh: n = 1 Hernia sac resection: n/a |
Durak et al. [31] | Laparoscopic repair of Morgagni hernia | 2007 | Retrospective, 2001–2005 | 5 | MLH | Laparoscopy: n = 5 Suture: n = 1 Suture + mesh: n = 0 Mesh: n = 4 Hernia sac resection: n = 0 |
Ambrogi et al. [12] | Transthoracic repair of Morgagni’s hernia: a 20-year experience from open to video-assisted approach | 2007 | Retrospective, 1985–2005 | 22 | MLH | Thoracotomy: n = 17 Transxiphoid hand-assisted thoracoscopy: n = 5 Suture: n = 16 Suture + mesh: n = 4 Mesh: n = 2 Hernia sac resection: n/a |
Yavuz et al. [32] | Laparoscopic repair of Morgagni hernia | 2006 | Retrospective, 2002–2004 | 5 | MLH | Laparoscopy: n = 5 Suture: n = 0 Suture + mesh: n = 0 Mesh: n = 5 Hernia sac resection: n = 0 |