Laparoscopic reduction and repair for incarcerated obturator hernia: comparison with open surgery.

Abstract

Transabdominal preperitoneal (TAPP) repair for obturator hernia (OH) is not well established. Therefore, we evaluated the efficacy of TAPP for OH repair compared with open surgery. We retrospectively analyzed patients who underwent surgery for OH at our hospital between 2006 and 2011. Since 2009, we have used TAPP repair for OH instead of open surgery. The clinical results of TAPP repair were compared with those of open surgery performed before 2008. Six patients with OH were treated by TAPP repair; occult contralateral OH was found by laparoscopic exploration in three (50 %) patients and was simultaneously repaired. Bowel incarceration was reduced by water pressure through Nelaton catheter in all but one patient. Bowel resection was performed in two patients after the laparoscopic assessment. For incarcerated OH, five of six cases were repaired using synthetic mesh, and the remaining case was addressed with simple peritoneal closure. Before 2008, six patients with OH underwent open surgery. The background of patients was comparable in the TAPP group and the open surgery group. There were no deaths in either group, but one metachronous contralateral OH occurred in the open surgery group within a short time frame, whereas none occurred in the TAPP group. TAPP repair, including the inspection of the viability of the incarcerated intestine and protective reduction and assessment of the entire groin area is an effective and minimally invasive strategy for OH patients.