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Open Versus Minimally Invasive Morgagni Hernia Repair in Pediatric Surgery: A Review
Dorsa Safari1, Zahra Mohajer1,2, Farbod Ghobadinezhad3
1Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Abstract:
Morgagni hernia (MH), a rare type of congenital diaphragmatic hernia, does not have an established protocol for surgical repair. A MEDLINE search with terms related to various surgical approaches to repair MH in children was conducted. Articles comprising robotic-assisted surgery, laparoscopy, laparotomy, thoracoscopy, and thoracotomy over the last 20 years were assessed. This narrative review provides an overview of MH in the pediatric population, covering the epidemiology, diagnosis, and management of this rare diaphragmatic hernia. We discuss various surgical techniques, including open and minimally invasive approaches, and compare their advantages and limitations in childhood MH repair. In addition, we address arguments for and against controversial topics such as hernia sac excision and patch reinforcement. Regarding MH in children, transabdominal repair is superior to transthoracic due to improved visualization of bilateral defects and easier reduction of the hernia contents. Laparoscopy has been reported as a popular approach. Single-site laparoscopy has gained attention due to better outcomes than standard three-port laparoscopy. Considering a limited number of children in the literature who underwent robotic MH repair, perioperative complications were reported to be minor.
Insights
Morgagni hernia (MH) repair in children lacks a standard protocol. Transabdominal laparoscopic approaches, especially single-site, offer advantages over transthoracic methods for this rare congenital diaphragmatic hernia.
Area of Science:
- Pediatric Surgery
- Congenital Abnormalities
- Surgical Techniques
Background:
- Morgagni hernia (MH) is a rare congenital diaphragmatic hernia with no established surgical repair protocol.
- Management strategies for pediatric MH require further elucidation.
Purpose of the Study:
- To provide a narrative review of Morgagni hernia in children.
- To compare various surgical techniques for pediatric MH repair, including open and minimally invasive approaches.
Main Methods:
- A MEDLINE search was conducted for pediatric MH surgical repair articles over the past 20 years.
- Reviewed studies included robotic-assisted surgery, laparoscopy, laparotomy, thoracoscopy, and thoracotomy.
Main Results:
- Transabdominal repair is superior to transthoracic repair in children for Morgagni hernia, offering better visualization and easier content reduction.
- Laparoscopic approaches, particularly single-site laparoscopy, are gaining popularity due to improved outcomes.
- Robotic repair in children shows promise with minor perioperative complications in limited studies.
Conclusions:
- Transabdominal laparoscopic repair is recommended for pediatric Morgagni hernia.
- Single-site laparoscopy demonstrates superior outcomes compared to standard multi-port laparoscopy.
- Further research on robotic repair for pediatric MH is warranted.
