eP40 Laparoscopic mesh repair of an adult congenital Morgagni hernia, a case report

Introduction Morgagni hernias are the most common congenital defect in the anterior parasternal portion of the diaphragm. Although they are rare in the adult population, they can present with a wide range of symptoms, from asymptomatic cases to those with clinically significant manifestations. This case report describes an adult patient with a Morgagni hernia who was successfully managed with laparoscopic surgery. Case Report A 73-year-old female presented with longstanding symptoms of exertional shortness of breath, epigastric pain, and constipation. An ultrasound revealed gallbladder stones, and the patient was scheduled for an elective laparoscopic cholecystectomy. During the procedure, a large anterior diaphragmatic hernia containing bowel was identified, prompting abandonment of the surgery to allow for further evaluation. A postoperative CT scan confirmed the presence of a large Morgagni hernia. The patient was subsequently scheduled for elective laparoscopic repair. Intraoperatively, a right anterior diaphragmatic defect was identified, with herniation of both the small and large bowel through the defect. The falciform ligament was divided to provide better exposure. The hernia contents were reduced, and the hernia sac was dissected, reduced, and excised. The diaphragmatic defect was closed using interrupted Ethibond sutures, and a 10x15 cm composite Parietex mesh was secured with absorbable tackers. The patient had an uneventful postoperative recovery and was discharged a few days later. Follow-up at six months postoperatively showed significant improvement in her symptoms. Conclusion Laparoscopic mesh repair of Morgagni hernias with sac excision, is a feasible and effective option in the hands of an experienced laparoscopic surgeon.