title: Repair of Morgagni Hernia in Adults with Primary Closure and Mesh Placement: First Robotic Experience.
abstract: BACKGROUND
  Morgagni hernia (MH) is an uncommon type of diaphragmatic hernia, especially in adults. Laparoscopic or thorascopic approaches have been described in adults. There are few reported cases using the Da Vinci robot in children and no previously described cases in adults. We report our early experience and technique using the robotic approach for MH repair in adults and its potential advantages.
  
  
  METHODS
  Robotic repair of MH was performed in 3 female patients. Four trocars were used to gain access to the abdomen. The hernia contents were reduced, the sac excised, and the defect closed primarily. A 4 × 6 inch bioabsorbable coating mesh was used in 2 patients and a biologic mesh in 1 for reinforcement.
  
  
  RESULTS
  Robotic repair of MH was technically successful in all 3 patients. The average operative time was 199.3 minutes, and difficult hernia exposure in one case caused prolonged surgical time. There were no intraoperative complications. Additional interventions, including a repair of a transverse colon serosal tear during the reduction of hernia contents, occurred in 1 patient. Two of the 3 female patients were discharged on postoperative day 1, whereas the other patient was discharged on postoperative day 3. There were no postoperative complications.
  
  
  CONCLUSIONS
  Robotic MH repair is an alternative minimally invasive approach for adults that allows for precise sac excision and primary tension-free repair with mesh reinforcement.
authors: 1 Department of General Surgery, Saint Vincent Hospital Indianapolis , Indianapolis, Indiana.
authors: Gabriel
authors: G
authors: Arevalo
authors: 1 Department of General Surgery, Saint Vincent Hospital Indianapolis , Indianapolis, Indiana.
authors: Kathryn
authors: K
authors: Harris
authors: 1 Department of General Surgery, Saint Vincent Hospital Indianapolis , Indianapolis, Indiana.
authors: Aziz
authors: A
authors: Sadiq
authors: 1 Department of General Surgery, Saint Vincent Hospital Indianapolis , Indianapolis, Indiana.
authors: Marius L
authors: ML
authors: Calin
authors: 2 Department of Surgery, Bronx-Lebanon Hospital , New York, New York.
authors: Baongoc
authors: B
authors: Nasri
authors: 1 Department of General Surgery, Saint Vincent Hospital Indianapolis , Indianapolis, Indiana.
authors: Kirpal
authors: K
authors: Singh
mesh_terms: D000368:Aged; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D061646:Operative Time; D019736:Prostheses and Implants; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D013526:Surgical Mesh; D058106:Wound Closure Techniques; D055815:Young Adult