Rare Case Report—Minimally Invasive Repair of Bilateral Morgagni Hernia Complicated by Diaphragmatic Rupture Secondary to Loss of Abdominal

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Surgical Endoscopy

Abstract

Bilateral Morgagni hernias are rare congenital diaphragmatic defects caused by the failure of fusion of the seventh costochondral arch with the pars sternalis. Chronic diaphragmatic hernias require challenging complex closure due to loss of the abdominal domain (also referred to as loss of domain (LOD)). Loss of domain involves the visceral content in the hernia sac being greater than the capacity of the abdominal cavity, which compromises tension-free hernia repair and poses an increased risk of compartment syndrome, fascial dehiscence, respiratory compromise, or poor bowel function. This case describes a 50-year-old male who underwent repair via a laparoscopic approach combined with right VATS and a Gore-Tex patch for a large bilateral Morgagni hernia; the patient then experienced complete diaphragm avulsion secondary to loss of domain and increased intraabdominal pressure and underwent reconstruction via right thoracotomy with Gore-Tex mesh. This case report discusses the challenges faced with loss of domain with chronic diaphragm hernias, parallel challenges faced in both diaphragm and abdominal hernia repairs, and the goals for techniques such as preoperative pneumoperitoneum and injection of Botulinum toxin into the lateral abdominal wall to be incorporated for preoperative optimization for large complex diaphragm hernia repairs, which both significantly lengthened the abdominal wall muscle and increased cavity compliance.

Volume

39

Issue

Suppl 1

First Page

S445

Comments

SAGES Annual Meeting, March 12–15, 2025, Long Beach, CA

Last Page

S445

DOI

10.1007/s00464-025-11690-9

ISSN

1432-2218

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