This is a case report and laparoscopic repair video presentation of a left-sided diaphragmatic hernia of Morgagni diagnosed in a 3 year old girl after the acute development of cough and difficulty breathing while on vacation.

There are three basic types of congenital diaphragmatic hernias (CDH). The posterolateral Bochdalek hernia is the most common CDH (90% of cases) and occurs in utero at approximately 6 weeks of gestation. The Morgagni hernia is less common (5 - 10%) and occurs in the anterior midline through the sternocostal hiatus of the diaphragm. Morgagni CDH's occur primarily on the right side (90%) and are usually not diagnosed until later on in life. The third CDH is the congenital hiatus hernia which is very rare. CDH constitutes a major surgical emergency in the newborn with an associated mortality rate of 60% or higher. Traditionally, morgagni hernias have been surgically repaired using the abdominal or thransthoracic approach. However, recent advances in endoscopic surgery have led to numerous case reports in the literature of laparoscopic repairs of CDH. Reported advantages of laparoscopic repair of CDH compared to open repair include a shorter length of stay and reduced morbidity.

Laparoscopic Repair of Morgagni Congenital Diaphragmatic Hernia. W.D.A. Ford and colleagues reported the technical aspects of their experience with laparoscopic repair of diaphragmatic defects in neonates and infants in 2004. We incorporated many of the technical recommendations by Ford et al into our laparoscopic approach of a left sided hernia of Morgagni diagnosed in a 3 year old girl. In the supine position, a 5-mm supra-umbilical port was placed using the Hassan canular technique. Two additional 5-mm ports were placed into the right and left upper quadrants under direct vision. The hernia sac was removed using sharp dissection and cautery. A hitch stitch was brought through the anterior abdominal wall to approximate the posterior and anterior remnants of the diaphragm. The defect was repaired using a running, locked Ethibond™ suture. An additional extracorporeal suture was placed in an area of perceived weakness. The patient was discharged within 36 hours without any post-operative complications.

Laparoscopic repair of a left sided diaphragmatic hernia of Morgagni is an attractive alternative to traditional abdominal or thoracic surgical approaches due to the perceived decreased in morbidity and length of hospital stay. The recurrence rate after laparoscopic repair compared to open repair is currently not known. Further studies with long term follow-up are necessary to determine if there is a difference in outcome between laparoscopic vs. open repair of diaphragmatic hernias.