Aim: Morgagni-Larrey hernia (MLH) is about 2-4% of all diaphragm hernias that is diagnosed incidentally. Besides laparoscopic or open approaches, different types of knot technics have been defined. Laparoscopy assisted repair is frequently preferred. However, a wide range of 0 to 42% recurrence ratio is reported. Owing to scarce number of patient data is limited in the literature, the underlying reason is controversial. We believe that, besides the defective margin of diaphragm, stretched suture between diaphragm and anterior abdominal wall is the matter for recurrence. Therefore, here our mesh supported laparoscopy assisted repair modification is presented.

Material: Between 2010 to 2021 records of patients treated for MLH were evaluated. Type of MLH, associated anomalies, surgical approach, demographic details and postoperative complications and recurrence are extracted.

Modification: We placed a 2*2 cm square, non-absorbable polyester mesh to the abdominal side of diaphragm while performing extracorporeal subcutaneous “u” suture knot tying technic. By means of mesh support, while knots are reinforced, a secured second layer of diaphragmatic edge is also achieved.

Results: A total of 10 patients, ages ranging between 6 days to 9 years, was undergone MLH repair. While respiratory symptoms were predominant, cardiac anomalies were frequent concomitant anomaly and trisomy was specified in two.
All but two not recurred; one following thoracoscopic the other after laparoscopy assisted repair Furthermore, the latter had two recurrences. Thereafter, we have performed modified technic in three patients without complication.

Conclusion: Consequently, low amount of patient and retrospective nature is weak points of the study. However, no complication or recurrence after modification is detected. It could be speculated that, with the diaphragmatic second layer a powered knot achieved. And hence, besides limited number, modification is safe, reliable and promising for laparoscopy assisted MLH repair.