Abstract
BackgroundSciatic hernias are rare pelvic floor hernias that occur through the sciatic foramen and often present as abdominal or pelvic pain, particularly in women. Historically, they were repaired using an open approach, with limited reports on their laparoscopic treatment.Case presentationHere we present the case of an 85-year-old woman who had repeated abdominal pain and was referred to our hospital for sciatic hernia surgery after conservative treatment. We laparoscopically observed the deep pelvis and identified the right sciatic hernia. When an extraperitoneal space was dissected, an ureterohypogastric nerve fascia (UNF) and a vesicohypogastric fascia (VF) were identified. Moreover, the maneuver to mobilize the fasciae inside from the pelvic wall made it possible to separate the ureter and urinary bladder, which might have otherwise incarcerated in the hernia. We repaired the defect of the sciatic foramen with a mesh plug and patch. The patient had an uneventful recovery, and the absence of sciatic herniation recurrence was confirmed 1 year after surgery.ConclusionA laparoscopic repair of a sciatic hernia could permit detailed non-invasive observations of the deep pelvis and be performed effectively by recognizing an UNF and a VF located near the sciatic foramen.
Highlights
Sciatic hernias are rare pelvic floor hernias that occur through the sciatic foramen and often present as abdominal or pelvic pain, in women
A laparoscopic repair of a sciatic hernia could permit detailed non-invasive observations of the deep pelvis and be performed effectively by recognizing an ureterohypogastric nerve fascia (UNF) and a vesicohypogastric fascia (VF) located near the sciatic foramen
The sciatic foramen is the orifice of the sciatic hernia, which is rarely approached by general surgeons from the abdominal cavity, and there is a lack its anatomical understanding
Summary
Sciatic hernia is one of the rarest forms of pelvic hernia, with only about 100 cases reported to date [1] It accounts for ~ 0.01% of all abdominal hernias [1, 2] and is more prevalent in females. Case presentation Four years ago, an 85-year-old woman experienced abdominal pain and consulted another hospital She was diagnosed with bowel obstruction and hospitalized; her symptoms were relieved by conservative treatment. Fujimoto et al Surgical Case Reports (2022) 8:9 was thought to be the cause of the intestinal obstruction After her symptoms were alleviated through conservative treatment, she was referred to our hospital. An ureterohypogastric nerve fascia (UNF) and a vesicohypogastric fascia (VF) were identified, and the fasciae were mobilized inside from the pelvic wall (Fig. 2b) This maneuver made it possible to separate the ureter and urinary bladder, which might have otherwise incarcerated in the hernia. Hernia recurrence was not observed on CT
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