. 2022;(2):24-29. doi: 10.17116/hirurgia202202124. https://pubmed.ncbi.nlm.nih.gov/35146996/
[Diagnostics and treatment of morgagni-larrey hernia]
- PMID: 35146996
- DOI: 10.17116/hirurgia202202124
Objective: To analyze the peculiarities of diagnosis, surgical treatment and laparoscopic suturing of Morgagni-Larrey hernia.
Material and methods: Morgagni-Larrey hernias were diagnosed in 20 out of 78 patients (26%) with diaphragmatic hernias. Mean age was 56 years. Nineteen patients had right-sided hernia, 1 patient – left-sided hernia. Abdominal approach was used in all cases.
Results: In 50% of patients, hernias were asymptomatic and found during X-ray examination. Symptoms were shortness of breath (4), cough (3), chest pain (1), epigastric pain (6), stool and gas retention (3), vomiting (1), belching (1). Hernia sac included omentum in all patients, transverse colon in 9 cases and small bowel in 1 patient. CT data completely coincided with intraoperative findings. Intraoperative dimension of hernia was 7.4±1.7 cm. Hernia sac was excised in all cases. Median laparotomy was performed in 10 patients, transrectal incision – in 3 cases. Laparoscopic suturing of hernia orifice with imposing 3-5 extracorporeal transfascial-muscular U-shaped polypropylene sutures was performed in 7 cases. We passed the thread through abdominal wall (two skin incisions up to 2 cm) and diaphragm using a straight needle for suturing the wound from the port EndoClose. Ligatures were tied in subcutaneous fatty tissue. No postoperative complications and recurrent hernias were observed.
Conclusion: Morgagni-Larrey hernias occur in adults aged over 50 years as a rule. These hernias are usually right-sided, asymptomatic in 50% of cases and detected during routine X-ray examination. Laparoscopic suturing of hernia orifice using extracorporeal transfascial-muscular sutures with fixation of ligatures in subcutaneous tissue ensures adequate closure of defect.
Keywords: Morgagni-Larrey hernia; diagnosis; extracorporeal sutures; laparoscopy; treatment.