Urgent laparoscopic repair of coexisting incarcerated giant Morgagni and hiatal hernias in an elderly patient: a case‑based technical note from a high‑volume surgical center.

The co-occurrence of a giant Morgagni hernia (MH) and a large hiatal hernia (HH) is exceedingly rare. We describe key operative steps of simultaneous surgical treatment of a large MH and HH, including surgical qualification, operating room setting, instrumentation, port placement, reduction of herniated viscera, methods of defect closure, and postoperative care. We present an unusual case of a 77-year-old woman with chronic constipation, abdominal pain, and loss of appetite, who was referred to a tertiary gastrointestinal surgery center after initial evaluation due to acute symptoms of gastrointestinal obstruction. Computed tomography showed a giant MH containing an incarcerated transverse colon and greater omentum, causing a considerable mediastinal shift toward the left. The examination also demonstrated a giant type III HH with most of the stomach displaced into the posterior mediastinum. The patient subsequently underwent a successful urgent minimally-invasive surgical repair. This technical note outlines the diagnostic challenges and details the laparoscopic approach used for the simultaneous repair of both complex diaphragmatic defects. This case highlights that even large, combined diaphragmatic hernias can be safely and effectively managed using advanced laparoscopic techniques, also in elderly patients.