V-05. Robotic Repair of Obstructed Large Morgagni Hernia

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ID: 325981
2026
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Ranked #58 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Background Morgagni hernias are rare anterior diaphragmatic defects that may present late in adulthood with non-specific or obstructive gastrointestinal symptoms. Diagnosis can be challenging, particularly when endoscopic findings are inconclusive. Surgical repair is recommended due to the risk of obstruction, incarceration, and strangulation. Minimally invasive approaches are increasingly utilised, with robotic surgery offering potential advantages in complex anterior diaphragmatic repairs. Methods We report the case of a 79-year-old female presenting with vomiting, abdominal pain, and inability to tolerate oral intake, with multiple similar episodes over preceding months. A recent oesophagogastroduodenoscopy showed no mucosal abnormalities but difficult angulation into the duodenum. Computed tomography demonstrated a Morgagni hernia with features of obstruction and possible incarceration. The patient underwent urgent robotic repair using a transabdominal pre-peritoneal approach. Following reduction of the herniated contents, the diaphragmatic defect was primarily closed with intracorporeal suturing and reinforced with pre-peritoneal mesh. Results The procedure was completed robotically without intraoperative complications. The robotic platform facilitated precise dissection and suturing in the confined retrosternal space. Postoperatively, the patient made an uncomplicated recovery with resolution of obstructive symptoms and successful return to oral intake. No early postoperative complications were observed. Conclusion Robotic transabdominal pre-peritoneal repair with primary closure and mesh reinforcement is a safe and effective approach for obstructed Morgagni hernia in elderly patients. The enhanced visualisation and dexterity afforded by the robotic platform support its use in the minimally invasive management of this rare but potentially serious condition. Video Description This surgical video demonstrates the diagnosis and robotic management of an obstructed Morgagni hernia in a 79-year-old female presenting with recurrent vomiting, abdominal pain, and inability to tolerate oral intake. The video opens with a concise clinical overview and cross-sectional CT imaging, illustrating the anterior diaphragmatic defect with herniation of abdominal contents and features of obstruction, highlighting the diagnostic challenge in elderly patients with non-specific symptoms and inconclusive endoscopic findings. The operative footage presents a step-by-step demonstration of a robotic transabdominal pre-peritoneal repair. Key stages include reduction of the herniated viscera, development of the pre-peritoneal plane, clear identification of the anterior diaphragmatic defect, primary closure using intracorporeal suturing, and reinforcement with pre-peritoneal mesh. Particular emphasis is placed on anatomical orientation, safe dissection in the confined retrosternal space, and technical considerations unique to this approach. This video is educationally valuable due to the rarity of obstructed Morgagni hernias in adults and the limited published visual material demonstrating robotic pre-peritoneal repair techniques. By integrating diagnostic imaging with detailed operative steps, the video provides a practical guide for surgeons managing complex anterior diaphragmatic hernias and showcases the advantages of robotic surgery in minimally invasive upper gastrointestinal and hernia surgery.
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Authors Jennifer Straatman
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.405
URL
https://doi.org/10.1093/dote/doag077.405
Keywords Keywords not found

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