An 82-year-old woman came to our hospital with chief complaint of nausea and vomiting that worsened after taking meal from 2 weeks ago. She had no epigastric pain or dysphagia or odynophagia and no weight loss was detected. She had no history of blunt trauma prior to this problem. A chest X-ray was done and showed round opacity with air-fluid level at right hemithorax on the dome of the diaphragm (). Biochemical marker was normal. On further workup, thoracic CT scan was performed and revealed part of the colon, omentum, and stomach herniated into the thorax. When the diagnosis is confirmed, the patient was prepared for laparoscopic surgery.\nAfter preoperative risk assessments including ECG, echocardiography, cardiologist consult, routine laboratory tests, and pulmonary function test, patients were prepared for surgical repair of the Morgagni hernia.\nPatients were placed in the supine position. A Foley catheter was inserted after general anesthesia. Pneumoperitoneum with carbonic dioxide (CO2) was performed by Veress needle. One 10 mm trocar port was inserted above the umbilicus and a camera (30° angulated optic) was inserted into the abdominal cavity. Two additional trocars (5 mm) were placed at the right and the left of the abdomen, and one 10 mm trocar was placed at the left flank, respectively. Subsequently, patients were putted on the reverse Trendelenburg positions. The anesthesiologist manually inflated the lungs to ensure positive pressure in order to facilitate the reduction of the sac contents. Intraoperatively, hernial sac content (colon, omentum, and part of stomach) was pulled out and reduced back into the abdominal cavity (). The falciform ligament was divided and the hernia sac was excised at first two cases by LigaSure (), but at operation of the third patient, the hernial sac had not been removed. The size of the defect was 6 × 7 cm in the first patient, 5 × 6 cm in the second patient, and 6 × 6 cm in the third patient. Dual-sided mesh (15 × 20 cm) was inserted into the abdominal cavity through the 10 mm port in all three cases. Mesh was expanded over the defect and fixed to the anterior abdominal wall and edge of the diaphragmatic defect in the posterior part with spiral tacks (Protack®, Covidien, Mansfield, MA, USA) (). After removal of the trocars under direct visualization, the fascial incision at the 10 mm trocar sites was closed via sutures. All patients were admitted to the SICU for the first postoperative day and discharged within 48 to 72 hours after surgery. All three cases were discharged ambulatorily and putted on normal diets. There was no complication such pneumomediastinum, fluid collection, or recurrence during 20 to 30 months of follow-up for all patient.
A 75-year-old woman with vague epigastric pain one year earlier was admitted to our hospital. Her epigastric pain worsened with large solid meals. She also suffer from nausea, vomiting, and constipation. Symptoms worsened since one month prior to admission. No sweating, palpitation, dyspnea, anorexia, weight loss, dysphagia, and odynophagia were detected. A chest X-ray (CXR) revealed the presence of a mass in the proximity of the right lung.