Laparoscopic treatment of morgagni-larrey diaphragmatic hernia

The Morgagni-Larrey hernia is a retrosternal or anterior diaphragmatic hernia covered with a sac. The defect is located anteromedially on either side of the junction of the septum transversum and the thoracic wall. A retrosternal defect to the right of the sternum is usually referred to as a hernia of Morgagni, whereas a hernia to the left of the sternum is often referred to as a hernia of Larrey (Becmeur et al. 2003; Lima et al. 2001a,b). Very rarely no sac is present in which case the defect extends into the pericardial space. Such defects are usually part of the pentalogy of Cantrell, and will not be considered here. Retrosternal hernias are usually discovered in older children or in adults when they can become symptomatic (Ipek et al. 2001; Rodriguez et al. 2003) due to intestinal involvement (occlusive symptoms) or when respiratory dysfunction occurs. In pediatric patients they are mostly discovered incidentally. Surgical treatment is indicated even if asymptomatic to avoid possible complications often described in adulthood (Rodriguez et al. 2003). Morgagni-Larrey hernias are an ideal indication for a laparoscopic repair (Becmeur et al. 2003; Georgacopulo et al. 1997; Ipek et al. 2002; Lima et al. 2001a,b; Newman et al. 1995; Rodriguez et al. 2003; van der Zee et al. 1999) and the technique is presented here. © Springer-Verlag Berlin Heidelberg 2008.