[Morgagni-Larrey anterior diaphragmatic hernias. Review of 13 cases].

OBJECTIVE: A review of anterior congenital diaphragmatic hernias (CDH) treated at our center, analysis of our experience and evolution in the surgical technique in pediatric patients over the last 15 years. MATERIAL Y METODOS: Estudio descriptivo retrospectivo de pacientes pediatricos intervenidos de HDC anterior (Morgagni, Larrey y Morgagni-Larrey) en nuestro centro entre 2000 y 2015, mediante revision sistematica de historias clinicas. Variables estudiadas: edad al diagnostico, edad al tratamiento, pruebas diagnosticas, sintomas, tecnica quirurgica, evolucion, complicaciones y recidivas. Fueron excluidas las hernias posteriores (Bochdaleck) y los pacientes mayores de 14 anos. RESULTS: 13 patients (8 females) with anterior diaphragmatic hernia. Mean age at diagnosis was 29.4 months (range fetal age 4 months-14 years old) and mean age at surgery 18.5 m (range 1 day-14 years). Three left hernias (Larrey hernia) and n= 2central hernias (Morgagni-Larrey). Two patients were diagnosed prenatally, the rest of them were casual diagnoses. Symptoms: n= 6 asymptomatic, n= 4respiratory symptoms, n= 1abdominal pain, n= 1both symptoms and n= 1 hydrops fetalis. In all cases, a chest X-ray was performed, CT in n= 5 cases and US in other n= 5 patients. The surgical approach was laparoscopic in n= 7 (1 conversion due to bleeding), thoracoscopic in n= 1 (requiring conversion to laparotomy due to technical difficulty), thoracotomy in n= 1patients and laparotomy in n= 4. Prosthetic patches were necessary in n= 2 patients. During the follow-up (3.9 years, range: 1-8), there were n= 2 recurrences (laparoscopy and thoracotomy) and n= 1 exitus 2 years after surgery, due to pathology not associated with diaphragmatic hernia. CONCLUSIONS: The minimally invasive approach is considered of choice in the literature. Our group considers that most patients with anterior CDH should be considered for a laparoscopic repair. The laparoscopic approach is easily reproducible and the conversion rate is low when it is performed by expert surgeons. However, the low prevalence of this pathology would require comparative and long-term multicenter studies to obtain statistically significant conclusions.