Morgagni hernia: transabdominal or transthoracic approach?

BACKGROUND

Morgagni hernias are rare and constitute less than 2% of all diaphragmatic hernias. Treatment is primarily surgical and transthoracic or transabdominal route approach methods are amenable. In this study, we compared the results of our Morgagni hernia cases, which underwent either transabdominal or transthoracic method of surgery.

METHODS

We retrospectively analyzed the records of 20 patients we operated on for Morgagni hernias between 1997 and 2011 in our clinic. Age, sex, presenting symptoms, lesion location, diagnoses, applied surgical method, duration of the hospital stay, morbidity and mortality rates were reviewed. Six of the cases were (30%) approached via thoracotomy and 14 (70%) were laparotomy. The hernial sac was resected in all cases. Diaphragmatic defects were repaired using nonabsorbable sutures in all cases except in one case where prolen mesh used.

RESULTS

Thirteen cases (65%) were female and seven (35%) were male. Mean age was 44.1 +/- 25.3 years (1-73 years). Hernias were located on the right side in 18 cases, the left side in one, and bilaterally located in one case. Herniated organs were: omentum in 19 (95%), transverse colon in 18 (90%), small bowel in 4 (20%), stomach in 3 (15%), and left lobe of the liver in one (5%) case. No complication was observed in patients who underwent laparotomy, and wound infection occurred in one patient who underwent thoracotomy. Hospital stays in thoracotomy and laparotomy groups are 7 and 6.2 days, respectively. There were no mortalities observed. There was no recurrence during the follow-up of 36.4 months (10-116 months).

CONCLUSION

Our findings showed that both surgical methods have similar and satisfactory results. Although transthoracic approach was preferred in previous cases, the transabdominal approach was preferred in later ones because we assumed that the later procedure is less invasive for the patient. We prefer and propose the abdominal approach for the surgical management of Morgagni hernias.

Pre-school children with hydatid lung disease

BACKGROUND

Hydatid cyst disease is a major health problem in developing countries and it usually settles in the lungs in children. This study aimed to present pre-school children with lung hydatid cysts cases that underwent surgical treatment.

METHODS

The authors retrospectively investigated 42 consecutive pre-school patients who were diagnosed and surgical treated for hydatid cysts in their clinic between January 1998 and December 2011.

RESULTS

Seventeen (40.5%) patients were female and 25 (59.5%) patients were male. The average age of the patients was 5.2 +/- 1.3 (between 2-7 years). The most common symptoms were cough (74%), chest pain (26.2%), and fever (26.2%). Twenty-eight cases had cysts in only one lung; in five cases, the cysts were in a single lung and the liver, in six cases, in bilateral lungs and liver, and in three cases, in bilateral lungs. The average cyst diameter was 6.2 +/- 2.4 (2-12) cm. In five cases, there were combined interventions to the right lung and liver cysts with a transdiaphragmatic approach. Nine patients with bilateral hydatid cysts underwent operations. Muscle protector thoracotomies were performed in eight cases. Cystotomy and capitonnage were applied to all lung cysts. One patient underwent a bronchoscopy for postoperative atelectasis. In one case, postoperative fever was observed. There was no postoperative mortality. Postoperative average hospital stay was 7.2 +/- 2.1 (3-13) days.

CONCLUSION

Surgery is the definitive treatment for lung hydatid cysts. The most important way to protect against the adverse effects of a thoracotomy is to eliminate the routes of transmission.