Robotic management of Morgagni hernias: a case series from a specialized hernia center.

introductionMorgagni hernias, a rare type of congenital diaphragmatic hernia, are typically asymptomatic and often diagnosed incidentally in adulthood. Despite their infrequent occurrence, surgical intervention is required in symptomatic cases or when complications arise. Traditionally, Morgagni hernias are managed through open surgery. However, recent advancements in robotic surgery offer potential benefits, including enhanced precision, reduced recovery times, and improved outcomes. This case series aims to explore the feasibility, safety, and outcomes of robotic-assisted repair of Morgagni hernias at a specialized hernia center.

methodsMedical records from all the patients who underwent ventral and Morgagni hernia repair were reviewed from December 2019 to December 2023. Patients with a surgical or radiological diagnosis of Morgagni hernias who underwent robotic repair were included for analysis. The protocol at our institute involves preoperative optimization, and myofascial release may be indicated for complex Morgagni defects associated with midline incisional hernias, while isolated Morgagni hernias are typically repaired by a transabdominal preperitoneal (TAPP) technique. Additionally, robotic repair has become the standard approach at our institution. Outcomes included patient demographics, preoperative symptoms, robotic surgical techniques, defect measurements, concomitant procedures, hospital length of stay (LOS), and postoperative complications. Complications analyzed comprised immediate postoperative and chronic pain, surgical site occurrences (SSO), surgical site infection (SSI), readmission and reoperation, recurrence.

resultsA total of 7 patients were identified through records review. The median age was 60 (IQR 53–71) years, and the sample was comprised by 5 (71.4%) females and 2 (28.6%) males. Median body mass index (BMI) was 34.3 kg/m2 (IQR 24.1–38.7). The most common symptom was pain (71.4%), and the majority of the patients presented a history of abdominal or thoracoabdominal surgery (85.7%). The median intraoperative defect length was 8 cm (IQR 6–11) and the median defect width was 4 cm (IQR 4–10). A total of 6 (85.7%) patients presented simultaneous midline incisional hernias, and transversus abdominis release (TAR) was required in 4 (57.1%) patients, while the other 3 (42.9%) patients underwent transabdominal preperitoneal (TAPP) repairs. Immediate postoperative pain was noted in 3 (42.9%) of the patients, of whom 2 (66.6%) underwent TAR. Also, one (14.3%) patient who underwent TAR presented with a seroma that did not require interventions. Within a median follow-up of 284 days (IQR 50–435), no recurrences or chronic pain were noted. One (14.3%) was deceased 6 months postoperatively due to metastatic pancreatic cancer.

conclusionRobotic repair of Morgagni hernias demonstrates a low complication rate, allowing for precise anatomical dissection and yielding excellent outcomes. However, it is a highly complex procedure that, in most cases, should be performed at specialized centers with expertise in this type of repair to ensure optimal results and patient safety.