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Congenital Morgagni's hernia: a national multicenter study.
J Pediatr Surg. 2014 Apr; 49(4):503-7.JP

Abstract

BACKGROUND

Congenital Morgagni's hernia (CMH) is rare and represents less than 5% of all congenital diaphragmatic hernias. This is a national review of our experience with CMH outlining clinical presentation, methods of diagnosis, associated anomalies, treatment, and outcome.

PATIENTS AND METHODS

The medical records of all patients with the diagnosis of CMH treated at four pediatric surgery units in Saudi Arabia were retrospectively reviewed for age at diagnosis, sex, presenting symptoms, associated anomalies, diagnosis, operative findings, treatment, and outcome.

RESULTS

During a 20-year period (January 1990-December 2010), 53 infants and children with CMH were treated. There were 38 males and 15 females. Their age at diagnosis ranged from 1 month to 9 years (mean 22.2 months). Forty-three (81%) presented with recurrent chest infection. Twenty-two (44.5%) had right CMH, 15 (28.3%) had left-sided hernia and 16 (30.2%) had bilateral hernia. In 7, the diagnosis of bilaterality was made at the time of surgery. Associated anomalies were seen in 38 (71.7%). Twenty-one (39.6%) had congenital heart disease, 8 (15%) had malrotation, and 15 (28.3%) had Down syndrome. All were operated on. Twenty-nine (54.7%) underwent repair via an open approach. The remaining 24 (45.3%) underwent repair using minimal invasive surgery, laparoscopic-assisted hernia repair (19 patients) or totally laparoscopic approach (5 patients). At the time of surgery, the hernia sac content included the colon in 33 (62.3%), part of the left lobe of the liver in 13 (24.5%), the small intestines in 11 (20.75%), the omentum in 5 (9.4%), and the stomach in 4 (7.5%). In 12 (22.6%), the hernia sac was empty. When compared to the open repair, the laparoscopic-assisted approach was associated with a shorter operative time, an earlier commencement of feeds, less requirement for postoperative analgesia, a shorter hospital stay, and better cosmetic appearance. There was no mortality. On follow-up, 2 (7%) of the open surgical group developed recurrence.

CONCLUSIONS

CMH is rare and in the pediatric age group commonly presents with recurrent chest infection and has a high incidence of associated anomalies, commonly congenital heart disease and Down syndrome. We advocate a laparoscopic-assisted approach to repair CMH. This is a simple technique that produces a sound repair, and when compared with the open approach it takes less operative time, requires less analgesia, allows earlier commencement of feeds, is associated with a shorter hospital stay, and has a better cosmetic outcome.

Authors+Show Affiliations

Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia. Electronic address: ahsalsalem@hotmail.com.Pediatric Surgery and Public Health, National Guard Hospital, Riyadh, Saudi Arabia and Alfaisal University, Emory University, and Ministry of Health, Riyadh, Saudi Arabia. Electronic address: zamakhshary@gmail.com.Department of pediatric Surgery, Military Hospital, Riyadh, Saudi Arabia. Electronic address: motrahib@hotmail.com.Department of pediatric Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia. Electronic address: qahtani@yahoo.com.Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia. Electronic address: Mohamedramadan_75@yahoo.com.Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia. Electronic address: abuyassin09@gmail.com.

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

24726101

Citation

Al-Salem, Ahmed H., et al. "Congenital Morgagni's Hernia: a National Multicenter Study." Journal of Pediatric Surgery, vol. 49, no. 4, 2014, pp. 503-7.
Al-Salem AH, Zamakhshary M, Al Mohaidly M, et al. Congenital Morgagni's hernia: a national multicenter study. J Pediatr Surg. 2014;49(4):503-7.
Al-Salem, A. H., Zamakhshary, M., Al Mohaidly, M., Al-Qahtani, A., Abdulla, M. R., & Naga, M. I. (2014). Congenital Morgagni's hernia: a national multicenter study. Journal of Pediatric Surgery, 49(4), 503-7. https://doi.org/10.1016/j.jpedsurg.2013.08.029
Al-Salem AH, et al. Congenital Morgagni's Hernia: a National Multicenter Study. J Pediatr Surg. 2014;49(4):503-7. PubMed PMID: 24726101.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Congenital Morgagni's hernia: a national multicenter study. AU - Al-Salem,Ahmed H, AU - Zamakhshary,Mohammed, AU - Al Mohaidly,Mohammed, AU - Al-Qahtani,Aayed, AU - Abdulla,Mohamed Ramadan, AU - Naga,Mohamed Ibrahim, Y1 - 2013/10/11/ PY - 2013/06/25/received PY - 2013/08/11/revised PY - 2013/08/20/accepted PY - 2014/4/15/entrez PY - 2014/4/15/pubmed PY - 2014/12/20/medline KW - Associated anomalies KW - Congenital Morgagni's hernia KW - Congenital diaphragmatic hernia KW - Treatment SP - 503 EP - 7 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 49 IS - 4 N2 - BACKGROUND: Congenital Morgagni's hernia (CMH) is rare and represents less than 5% of all congenital diaphragmatic hernias. This is a national review of our experience with CMH outlining clinical presentation, methods of diagnosis, associated anomalies, treatment, and outcome. PATIENTS AND METHODS: The medical records of all patients with the diagnosis of CMH treated at four pediatric surgery units in Saudi Arabia were retrospectively reviewed for age at diagnosis, sex, presenting symptoms, associated anomalies, diagnosis, operative findings, treatment, and outcome. RESULTS: During a 20-year period (January 1990-December 2010), 53 infants and children with CMH were treated. There were 38 males and 15 females. Their age at diagnosis ranged from 1 month to 9 years (mean 22.2 months). Forty-three (81%) presented with recurrent chest infection. Twenty-two (44.5%) had right CMH, 15 (28.3%) had left-sided hernia and 16 (30.2%) had bilateral hernia. In 7, the diagnosis of bilaterality was made at the time of surgery. Associated anomalies were seen in 38 (71.7%). Twenty-one (39.6%) had congenital heart disease, 8 (15%) had malrotation, and 15 (28.3%) had Down syndrome. All were operated on. Twenty-nine (54.7%) underwent repair via an open approach. The remaining 24 (45.3%) underwent repair using minimal invasive surgery, laparoscopic-assisted hernia repair (19 patients) or totally laparoscopic approach (5 patients). At the time of surgery, the hernia sac content included the colon in 33 (62.3%), part of the left lobe of the liver in 13 (24.5%), the small intestines in 11 (20.75%), the omentum in 5 (9.4%), and the stomach in 4 (7.5%). In 12 (22.6%), the hernia sac was empty. When compared to the open repair, the laparoscopic-assisted approach was associated with a shorter operative time, an earlier commencement of feeds, less requirement for postoperative analgesia, a shorter hospital stay, and better cosmetic appearance. There was no mortality. On follow-up, 2 (7%) of the open surgical group developed recurrence. CONCLUSIONS: CMH is rare and in the pediatric age group commonly presents with recurrent chest infection and has a high incidence of associated anomalies, commonly congenital heart disease and Down syndrome. We advocate a laparoscopic-assisted approach to repair CMH. This is a simple technique that produces a sound repair, and when compared with the open approach it takes less operative time, requires less analgesia, allows earlier commencement of feeds, is associated with a shorter hospital stay, and has a better cosmetic outcome. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/24726101/Congenital_Morgagni's_hernia:_a_national_multicenter_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(13)00721-5 DB - PRIME DP - Unbound Medicine ER -