One-stage Laparoscopic Repair of Morgagni and Inguinal Hernias in a Two-month Old Male
A 45-day-old male weighing 4,030 g with a length of 54.8 cm presented to the hospital with unexplained persistent irritability and decreased feeding. A plain chest X-ray showed an abnormal air shadow below the sternum (). The patient was the second born of twins at 36 weeks and five days of gestation. His birth weight was 2,070 g. The right inguinal hernia was treated with surgery 33 days after birth at another hospital. The Morgagni diaphragmatic hernia and left inguinal hernia were diagnosed using computed tomography of the chest and abdomen ().\nAn operation was performed 66 days after birth, at that time the patient's weight was 4,100 g. A one-stage aparoscopic repair was planned to repair the Morgagni and left inguinal hernias. Under general anesthesia, the patient was placed in the supine position. Three trocars were inserted (). A 3.5 cm diaphragmatic defect was found behind the sternum. The transverse colon was herniated through the diaphragmatic defect, which did not have an anterior rim. The hernial sac was well formed. The small bowel was herniated though the left internal inguinal ring. The transverse colon with the hernia sac was pushed back into the abdominal cavity, and then the hernia sac was removed. The diaphragmatic defect was repaired primarily with 2-0 black silk interrupted sutures. The small bowel was reduced, and the internal inguinal ring was repaired with a 3-0 black silk purse-string suture. There were no complications during the operation. The patient was discharged uneventfully on postoperative day 7. At the 1 year follow-up, there was no recurrence of the hernias.