# Laparoscopic repair of Morgagni hernia by primary closure with extra-abdominal suture: a case report and review of the literature

## TL;DR

A case report describes a successful laparoscopic repair of a Morgagni hernia using primary closure without mesh, and suggests a size criterion for mesh use.

## Contribution

The paper introduces a size-based criterion for mesh utilization in laparoscopic Morgagni hernia repair.

## Key findings

- Primary closure with extra-abdominal suture successfully repaired a 6 x 3 cm Morgagni hernia in an 87-year-old patient.
- The review suggests primary closure is suitable for hernia defects with width <4 cm and length <7 cm.
- The patient had no complications and no recurrence at 9-month follow-up.

## Abstract

We report a case of a Morgagni hernia repaired by primary closure with an extra-abdominal suture. Moreover, we reviewed cases of laparoscopically repaired Morgagni hernia, in which the size of the hernia defect was known, to establish a size criterion for mesh utilization. An 87-year-old woman presented to our hospital with right upper abdominal pain and vomiting. She had no history of abdominal surgery or trauma. Chest radiography and computed tomography (CT) revealed a Morgagni hernia, with the stomach and transverse colon herniated into the right chest cavity. Initially, an endoscopic repair was performed for the herniated stomach due to her age, which was successful. However, she had a recurrence 2 days later, prompting us to perform a semi-emergent laparoscopic surgery. Laparoscopic examination revealed a Morgagni defect, with the omentum, transverse colon, and stomach herniated, with the stomach reduced by pneumoperitoneum. Fortunately, the herniated organs could be easily relocated into the abdomen with no adhesions. The hernia defect measured 6 x 3 cm. We performed primary closure with an extra-abdominal suture. No sac resection was performed. The operation lasted 98 min. Oral intake was initiated on postoperative day 1, and the patient was discharged on postoperative day 3 without complications. Chest radiography and CT scans at 1 month postoperatively showed no recurrence, and the patient remained asymptomatic at the 9-month follow-up examination. According to our review findings, primary closure is an efficient method for small hernia defects (rule of thumb: width, <4 cm; length, <7 cm).