Morgagni hernia surgery treatment in Noida Delhi
Morgagni hernia surgery treatment is available with us. Morgagni hernia is a rare variety of hernia presenting in early adult life or adolescents.
Morgagni hernias are rare finding in the adult population and represent 1%–3% of all congenital diaphragmatic hernias. These retrosternal diaphragmatic hernias develop from a congenital failure of the pars sterna to fuse with the costal arches.
Most commonly, these hernias occur on the right; however, rarely, they can occur on the left, termed a Morgagni-Larrey hernia.
Unlike infants who frequently present with acute respiratory distress or failure, adults may present with chronic symptoms or a Morgagni hernia may be found incidentally.
Due to the risk of incarceration or atelectasis, surgical treatment is recommended for Morgagni hernias identified in the adult population.Multiple approaches to these rare hernias have been described in the literature.Surgery is the only treatment available.
Dr Nitin Jha is available to help you understand this problem
We present the laparoscopic surgery for morgagni hernia.
Morgagni hernias are one of the congenital diaphragmatic hernias (CDH), and is characterized by herniation through the foramen of Morgagni. When compared to Bochdalek hernias, Morgagni hernias are:
- anterior
- more often right-sided (~90%)
- small
- rare (~2% of CDH)
- at low risk of prolapse
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Clinical presentation
Only ~30% of patients are symptomatic. Newborns may present with respiratory distress at birth similar to a Bochdalek hernia. Additionally, recurrent chest infections and gastrointestinal symptoms have been reported in those with previously undiagnosed Morgagni hernia.
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Pathophysiology
It involves three major defects:
- A failure of the diaphragm to completely close during development
- Herniation of the abdominal contents into the chest
- Pulmonary hypoplasia
Diagnosis
Congenital diaphragmatic hernia: coronal obstetric ultrasound (head to right of image, thorax centre, abdomen left) shows the stomach and heart both within the thorax.
This condition can often be diagnosed before birth and fetal intervention can sometimes help, depending on the severity of the condition. Infants born with diaphragmatic hernia experience respiratory failure due to both pulmonary hypertension and pulmonary hypoplasia. The first condition is a restriction of blood flow through the lungs thought to be caused by defects in the lung. Pulmonary hypoplasia or decreased lung volume is directly related to the abdominal organs presence in the chest cavity which causes the lungs to be severely undersized, especially on the side of the hernia.
Survival rates for infants with this condition vary, but have generally been increasing through advances in neonatal medicine. Work has been done to correlate survival rates to ultrasound measurements of the lung volume as compared to the baby’s head circumference. This figure known as the lung to head ratio (LHR). Still, LHR remains an inconsistent measure of survival. Outcomes of CDH are largely dependent on the severity of the defect and the appropriate timing of treatment.
A small percentage of cases go unrecognized into adulthood.
Pathology
Morgagni hernias most often contain omental fat, but transverse colon (60%) or stomach (12%) may be included within the hernia.
Associations
- pentalogy of Cantrell
- congenital heart disease
- trisomy 21 (Down syndrome)
- intestinal malrotation
Treatment and prognosis
Some sources recommend laparoscopic surgical repair, even in asymptomatic patients, to avoid the risk of strangulation of the hernia contents 6.
Differential diagnosis
- cardiophrenic angle lesions: the main differential diagnosis for Morgagni hernia is a cardiophrenic fat pad. It appears radiolucent compared with other lesions not containing fat
- focal diaphragmatic eventration
- diaphragmatic rupture: from trauma, but usually other supportive signs of chest and/or abdominal trauma would be apparent. This is most commonly seen posterior and posterolaterally