Minimally invasive repair of Morgagni hernia - A multicenter case series

A novel GRK2 variant in a patient with Jeune asphyxiating thoracic dysplasia accompanied by Morgagni hernia

Skeletal ciliopathies constitute a subgroup of ciliopathies characterized by various skeletal anomalies arising from mutations in genes impacting cilia, ciliogenesis, intraflagellar transport process, or various signaling pathways. Short-rib thoracic dysplasias, previously known as Jeune asphyxiating thoracic dysplasia (ATD), stand out as the most prevalent and prototypical form of skeletal ciliopathies, often associated with semilethality. Recently, pathogenic variants in GRK2, a subfamily of mammalian G protein-coupled receptor kinases, have been identified as one of the underlying causes of Jeune ATD. In this study, we report a new patient with Jeune ATD, in whom exome sequencing revealed a novel homozygous GRK2 variant, and we review the clinical features and radiographic findings. In addition, our findings introduce Morgagni hernia and an organoaxial-type rotation anomaly of the stomach and midgut malrotation for the first time in the context of this recently characterized GRK2-related skeletal ciliopathy.

Laparoscopic assisted anterior transabdominal wall closure using loop suture removing technique in Morgagni hernia: safe and easy method

PURPOSE

The treatment of MH entails surgical repair either by open abdominal or thoracic approaches or by minimal invasive surgery. The aim of this study is to evaluate the surgical and clinical outcomes of children who underwent laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique.

METHODS

This retrospective study includes pediatric patients who underwent surgery for MH between January 2015 and February 2019. The patients' demographic data, symptoms, operative findings and technique and postoperative outcomes were recorded.

RESULTS

A total of 17 children with MH were treated. There were 13 boys (76.5%) and four (23.5%) girls. Six patients had trisomy 21 (37%). The mean operation time was 40 min (25-90 min). The hernia sac was removed in all patients and there was no need for prosthetic patch in any of the children. Mean time to start feeding was 10 h (6-24 h). The mean hospitalization time was 2 days (1-5 days). There were no complications intraoperatively or postoperatively. The mean follow-up time was 24 months (6-40). No recurrence occurred during the follow-up time.

CONCLUSION

Laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique is a preferable method with excellent outcomes and short hospitalization and feeding time postoperatively. This technique may be performed easily and safely without requiring any additional experience other than basic laparoscopy skills.

Pediatric Morgagni diaphragmatic hernia: a descriptive study

INTRODUCTION

The Morgagni hernia (MH) accounts for 3-4% of congenital diaphragmatic hernias. There is a paucity of data regarding this rare defect. The purpose of this study is to describe the characteristics of children with MH, surgical approaches for repair, and patient outcomes.

METHODS

Pediatric patients (ages 0-18) with a MH from 2002 to 2014 at a single, freestanding pediatric hospital were retrospectively reviewed. Patient presentation, demographics, operative methods and findings, and outcomes were evaluated.

RESULTS

Twenty-six infants and children with a congenital MH were treated. There were 20 males (77%) and six females (23%) with a median age at diagnosis of 14.75 months (range 1 week to 13 years). Half were symptomatic. Sixteen hernias were repaired laparoscopically, nine by an open approach, and one laparoscopic converted to open. Colon was the most commonly herniated organ (N = 14). Hernia sacs were found in 22 patients of which, 20 were resected. Two patients underwent treatment with ECLS. There was one mortality in a patient who underwent repair on ECLS in the setting of an omphalocele and SVC obstruction. There were no recurrences in our sample.

CONCLUSION

In this series, congenital MH appears to have a male predominance, frequently presents with pulmonary symptoms, and has excellent outcomes regardless of operative approach.

Hernia of Morgagni Presenting as Constipation in a 65-Year-Old Male

Hernia of Morgagni is congenital defects in the diaphragm. They are mostly asymptomatic and present with vague symptoms when they do so. A high index of suspicion is required for timely diagnose of this condition. Here we present the case of a 65-year-old male patient presented to our institute with constipation for the past six months. Chest radiology raised the suspicion of a hernia which was further confirmed by contrast studies. Laparotomy was done and the hernia sac identified, colon and greater omentum reduced and defect repaired. He was discharged in stable condition and was doing well on follow-up.