(1)
Department of Paediatric Surgery, Birmingham Children’s Hospital, Birmingham, UK
Abstract
A Morgagni (anterior) diaphragmatic hernia is usually diagnosed on a chest x-ray in a child with recurrent respiratory symptoms. The Morgagni hernia lends itself easily to a laparoscopic repair.
Keywords
Morgagni (anterior) diaphragmatic herniaLaparoscopic repair15.1 General Information
A Morgagni (anterior) diaphragmatic hernia is usually diagnosed on a chest x-ray in a child with recurrent respiratory symptoms. The Morgagni hernia lends itself easily to a laparoscopic repair.
15.2 Working Instruments
3-mm or 5-mm straight and curved graspers
Hook diathermy
Needle holder
Laparoscopic suture retriever
2/0 Nonabsorbable sutures
5-mm umbilical port and two 3-mm or 5-mm working ports
0° or 30°, 5-mm laparoscope
15.3 Positioning, Port Siting, and Ergonomic Considerations
The patient is positioned supine towards the foot of the table. The legs can be placed in the frog-leg position or hung over the edge at the knees. The monitor is placed over the patient’s lower chest. The surgeon stands at the foot of the table.
15.4 Relevant Anatomy
The hernia is in the midline and anterior. The transverse colon may be within the sac and can be easily removed with traction. There is normally a well-developed posterior rim but no anterior rim. The pericardium and pleura can be seen just outside the fundus of the sac (Fig. 15.1).
Fig. 15.1
The transverse colon may be seen within the sac of the Morgagni hernia. There is normally a well-developed posterior rim (P) and no anterior rim (A). The pericardium and pleura can be seen just outside the fundus of the sac
15.5 Surgical Technique
- 1.
The first 5-mm port is inserted with an open technique via the umbilicus. A pneumoperitoneum of 8–10 mmHg with flows of 1.5–2 L/min is established. Two additional working ports are inserted superior to the umbilicus and at the right and left midclavicular lines, to produce effective triangulation. The hernia contents are reduced.
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