Obturator Hernia Research Articles

Retrospective comparison of laparoscopic and open surgery for obturator hernia: a single-center experience

PurposeThis retrospective cohort study aims to compare perioperative outcomes between laparoscopic and open surgical repair of obturator hernia, a rare but clinically significant abdominal wall hernia. MethodsWe analyzed 13 consecutive patients with CT-confirmed obturator hernia causing small bowel obstruction (2017–2023). Six underwent open repair and seven received laparoscopic transabdominal preperitoneal (TAPP) repair with mesh. Outcomes included operative time, blood loss, hospitalization duration, and CRP levels.ResultsLaparoscopic repair significantly reduced hospitalization duration (median 7 vs. 13 days; P = 0.049) and postoperative inflammation (CRP 10.66 vs. 79.07 mg/L; P = 0.003), with less blood loss (10 vs. 30 mL; P = 0.001). No recurrences occurred during 12-month follow-up.ConclusionsLaparoscopic obturator hernia repair demonstrates advantages in reducing hospital stay, minimizing surgical trauma, and attenuating systemic inflammatory response as compared to open approach. However, larger multicenter studies are warranted to validate these findings given the limited sample size.

Obturator Hernia, an unusual cause of small bowel obstruction: Radiographic and surgical findings

Obturator hernia is a rare condition, it contributes to about 1% of incidence of all hernias, even less frequently are they diagnosed preoperatively, with the vast majority being found incidentally at laparotomy for small bowel obstruction. Diagnosing an obturator hernia clinically is a challenging one due to vague signs and symptoms. Pelvic CT is almost 100% accurate in the diagnosis of obturator hernia and should be the modality of choice in older patients presenting with intestinal obstruction of unknown etiology. This case report describes a thin elderly woman, with a history of 5 days acute abdominal pain, which was correctly diagnosed before surgery as an incarcerated obturator hernia using CT.

Emergency Minimally Invasive Surgery for Obturator Hernias: A Systematic Review.

Despite their rarity, obturator hernias pose significant clinical challenges due to their high complication rate and frequent emergency presentation. While minimally invasive surgery has proven effective and safe for elective groin hernia repair, its application in emergency settings, particularly for obturator hernias, lacks robust evidence, highlighting a critical knowledge gap in this area. This systematic review aims to evaluate the feasibility of a minimally invasive approach for the repair of obturator hernias in emergency settings. A systematic review was conducted searching PubMed, OVID, MEDLINE, Embase, and Cochrane reviews for ((obturator hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). The time of the literature is from the establishment of each database to 1 September 2023. Critical appraisal used the Joanna Briggs Institute (JBI) appraisal checklist. A systematic review of 337 manuscripts identified 47 relevant studies, including 39 case reports, 4 case series, and 4 retrospective studies. Minimally invasive approaches, particularly totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), and the Kugel procedure, demonstrated favourable outcomes for obturator hernias, including shorter operative times, reduced hospital stays, low recurrence rates, effective management of complications, and improved diagnostics, with success dependent on timely intervention, bowel viability, and patient selection. The findings suggest that minimal access surgery can effectively avoid unnecessary laparotomy for hernial content assessment, particularly when employing the TAPP approach. While emergency repair of obturator hernias using minimal access techniques appears feasible and safe, achieving outcomes comparable to open surgery requires further high-quality evidence. PROSPERO: CRD42024503724.

Hip pain in elderly women: Do not forget the obturator hernia

Hip pain in elderly women: Do not forget the obturator hernia

Acute intestinal obstruction, difficulties in diagnosis in starged hernias of the opturate forana and surgical tactics

Relevance. Hernias of the obturator canal are extremely rare in surgical practice. This type occurs in 0.07% to 1% of all known hernias, in which the contents of the pelvic or abdominal organs penetrate through the obturator foramen. The hernias in question occur predominantly in elderly women of low nutrition with a large history of childbirth. This is explained by the peculiarities of the anatomical structure of the female pelvis: its pronounced slope, the larger size of the obturator foramen, the more vertical position of the obturator canal compared to the male, and the weakness of the pelvic floor muscles. Diagnosing an obturator hernia is very difficult. Being difficult to diagnose cases, strangulated hernias of the obturator canal are detected at the treatment stage and are accompanied by high mortality. Mortality for these manifestations ranges from 12% to 70%, with postoperative measurements in 11.6% of cases. These statistics provide the majority of observations provided by reputable Japanese colleagues [3]. Conclusions. Hernias of the obturator foramen, due to their rare occurrence and lack of clear clinical manifestations, are difficult diagnostic cases. Knowledge of the symptoms characteristic of this pathology, the use of computed tomography of the abdominal cavity and pelvis with contrast enhancement is extremely important, influencing the adoption of a reliably correct, quick decision for surgical intervention, largely determining the outcome of the disease. Specific diagnostics for determining obturator foramen hernia are not covered in clinical recommendations. Due to the fact that this clinical pathology is quite complex for a surgeon to quickly determine, it is detected at the stage of complications and is accompanied by high mortality. The leading clinical picture for a strangulated hernia of the obturator foramen is signs of intestinal obstruction. Correctly and timely preoperative diagnosis is crucial for the surgeon to decide on tactics. In the case of a clinical picture of intestinal obstruction, one should act on the basis of national clinical recommendations, not forgetting to manually check the location of the hernia, which will significantly reduce the time for diagnostic searches and reduce postoperative mortality in case of a strangulated hernia of the obturator foramen.

Endogenous Causes of Obturator Nerve Entrapment: Literature Review and Proposal of a Treatment Algorithm.

Background: Obturator nerve entrapment can result from endogenous and exogenous causes. Due to its long course, which includes both endopelvic and exopelvic segments, the nerve is susceptible to irritation from multiple etiologies. However, as obturator nerve entrapment is relatively uncommon, a thorough understanding of endogenous factors contributing to nerve entrapment is lacking. Nevertheless, understanding the endogenous factors contributing to obturator nerve entrapment is crucial for an effective treatment approach. Material and Methods: We performed a systematic literature search on studies investigating the diagnostic and (surgical) therapeutic approaches to obturator neuropathy due to endogenous causes. Studies were grouped according to the etiology responsible for nerve irritation. Lastly, data were synthesized to create a clinical work-up flowchart for obturator nerve entrapment syndromes due to endogenous causes. Results: Data from 45 studies comprising 175 patients met our inclusion criteria. We were able to summarize these data into six broad etiologies (tumor, obturator hernia, endometriosis, cystic lesions, vascular, and idiopathic causes) responsible for nerve irritation and saw that the most important factors for therapy are the onset of the symptoms and the anatomical localization. MRI emerged as the most valuable diagnostic tool for chronic conditions, especially in identifying the precise etiology and location of nerve compression. Conclusions: This review offers a structured framework for diagnosing and managing obturator nerve entrapment due to endogenous causes. We propose a diagnostic and therapeutic algorithm based on the identified etiologies to facilitate clinical decision-making.

Laparoscopic Repair of Ureteral Obturator Hernia Using Extended TAPP Technique: A Case Report.

BACKGROUND Obturator hernias are very rare and mostly affect elderly women. Among these, obturator hernia with ureteral entrapment is exceptionally rare. Diagnosis and surgical treatment can be very difficult and is usually performed by an open surgical technique. Here we present the first published case of a ureteral obturator hernia where a laparoscopic extended transabdominal preperitoneal patch technique (TAPP) was performed for hernia repair. CASE REPORT In this case, a 79-year-old woman was referred to the emergency department because of right-sided flank pain that had been present for weeks with pain exacerbation since the previous evening. Imaging of the urinary tract showed distal herniation of the ureter into the right obturator canal. Laparoscopic hernioplasty with mobilization of the bladder, release of the right ureter from the obturator hernia, and simultaneous treatment of an additionally incidentally discovered femoral hernia by mesh implantation using an extended TAPP technique was performed. In addition to the primary hernia repair, careful dissection and protection of the ureter during surgery ensured optimal preservation of its function. This approach ensured protection of the ureter from further adhesions, with precise mesh positioning and fixation, preventing any damage to surrounding structures, including the intestine. The patient was discharged on the third day after surgery without any wound infections, dysesthesia, or bladder dysfunction. CONCLUSIONS By presenting this case report we hope to increase the awareness of rare hernias such as obturator hernias. Physicians should make accurate diagnosis based on physical examination, laboratory investigations, and imaging. The patient's uneventful recovery and lack of postoperative complications underscore the benefits of laparoscopic approaches even in rare cases, offering reduced morbidity and quicker recovery compared to traditional open surgery.

Acute incarcerated obturator hernia.

Obturator hernia is a rare cause of intestinal obstruction that can be challenging to diagnose due to unspecific clinical presentation. A woman in her eighties with a history of involuntary weight loss presented to the emergency department due to acute pain in her right thigh, nausea and vomiting. On examination, the patient exhibited tenderness to palpation in the proximal and medial aspect of her right thigh. Abdominal computed tomography revealed a loop of small bowel protruding through the right obturator canal, consistent with an incarcerated obturator hernia. An emergency laparoscopy was performed, revealing that the affected small bowel segment was viable after reduction of the hernia. Due to development of respiratory acidosis and hypotension, the obturator defect was primarily sutured to reduce operating time. The patient made a good recovery and was transferred to the medical ward for further evaluation of her weight loss. This case illustrates the diagnostic challenge associated with obturator hernias.

Advantages of ultrasound-guided reduction and elective surgery versus emergency repair for incarcerated obturator hernia.

To compare the benefits of ultrasound-guided reduction (UGR) followed by elective versus emergency repair for incarcerated obturator hernia (OH). This is a retrospective cohort study. Before UGR implementation, all patients with incarcerated OH underwent emergency surgery. To compare the UGR candidates fairly, only patients who did not require bowel resection were classified as the emergency group. Following UGR implementation, the patients without bowel necrosis, based on our criteria, underwent UGR. Among these, those who underwent elective repair were classified into the elective group. The surgical outcomes were compared between the groups and are presented as the median (range). Among the 60 patients with incarcerated OH, 23 were in the emergency group and 11 in the elective group. UGR was successful in 16 of 17 cases (94%). The elective group had significantly shorter times to first defecation (4 [1-7] vs. 0 [0-1]) and meal initiation (3 [1-8] vs. 1 [1-3] days) than the emergency group. Although not statistically significant, the mesh repair rate was higher in the elective group (100% vs. 78%, respectively). UGR can be safely performed with an appropriate diagnosis. Compared with emergency surgery, UGR followed by elective repair led to reduced postoperative ileus and elevated mesh repair rates.

Unilateral Obturator Hernia in an Elderly Male: A Case Report

Obturator Hernia (OH) is a rare type of pelvic hernia in which abdominal contents protrude through the obturator canal. This condition can lead to bowel obstruction, gangrene, or ischaemia, all of which pose significant risks and can be life-threatening. OH predominantly affects elderly, thin females and often remains asymptomatic until there is compression of the obturator nerve. As a result, OH should be considered in the differential diagnosis of intestinal blockages of unknown origin. For preoperative diagnosis, Computed Tomography (CT) is regarded as the optimal imaging modality. However, Ultrasonography (USG) may sometimes misidentify it as a femoral or inguinal hernia. Due to its non specific symptoms and clinical presentations, early preoperative identification of OH can be challenging. Hereby, the authors present a case of OH in an 80-year-old male patient with biopsy-proven prostate carcinoma who reported burning sensations and difficulty in micturition over the past month. His medical history included insulin-managed diabetes and extensive alcohol consumption. Physical examination revealed a non tender swelling on the medial aspect of the right upper thigh, prompting imaging studies that included a Kidney, Ureter, and Bladder (KUB) radiograph and a CT-KUB. The radiograph showed a radiolucent area in the right obturator canal, while the CT confirmed the diagnosis, revealing a herniated sac within the obturator externus muscle, measuring 61×109×89 mm, with associated bone remodelling of the pubic symphysis and mild prostatomegaly. Despite understanding the risks, the patient has not yet undergone surgery due to his age and co-morbidities. The present case underscores the need for heightened awareness of OH in elderly males, especially those with significant medical histories, as early recognition and intervention are crucial to preventing serious complications.

EP39 Emergency Minimally Invasive Surgery for Obturator Hernias: A Systematic Review of the Literature

Abstract Background Despite their rarity, obturator hernias pose significant clinical challenges due to their high complication rate and frequent emergency presentation. While minimally invasive surgery has proven effective and safe for elective groin hernia repair, its application in emergency settings, particularly for obturator hernias, lacks robust evidence, highlighting a critical knowledge gap in this area. Methods A systematic review was conducted searching PubMed, OVID, Embase, and Cochrane reviews for ((Obturator hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). Results A systematic review of 337 manuscripts identified 47 relevant studies, including 39 case reports, 3 case series, and 5 retrospective studies. Conclusion The findings suggest that minimal access surgery can effectively avoid unnecessary laparotomy for hernial content assessment, particularly when employing the TAPP approach. While emergency repair of obturator hernias using minimal access techniques appears feasible and safe, achieving outcomes comparable to open surgery requires further high-quality evidence.

Iatrogenic Obturator Hernia with Ureter as Content: Case Report

A male in his early 70s presented with complaints of bilateral flank pain for seven months, hematuria for 2 days along with the passage of clots associated with an increased frequency of urination and nocturia. The patient had a history of deep vein thrombosis and was on anticoagulation. On ultrasound, multiple calculi with posterior acoustic shadowing were seen in bilateral kidneys, corroborated by Computed Tomography (CT) urography. Laser lithotripsy with DJ stent placement was conducted. The follow-up CT urography showed an inferiorly displaced DJ stent within the right distal ureter and the DJ stent herniating through the right obturator foramen. The right-sided DJ stent was removed after a month. For obturator hernia, the patient is being kept in the follow-up. This case report reviewed the literature and discussed the diagnosis and complications associated with the obturator hernia with the ureter as the content.

An Interesting Case of Strangulate Left Obturator Hernia with Intestinal Obstruction and Septic Shock

An Interesting Case of Strangulate Left Obturator Hernia with Intestinal Obstruction and Septic Shock

Increased length of incarcerated small bowel as a risk factor for intestinal necrosis in obturator hernia.

Incarcerated obturator hernia (OH) is a rare type of pelvic wall hernia. With the increasing adoption of reduction techniques for incarcerated OH, it is crucial to assess the extent of damage to the incarcerated intestine. This study aimed to identify objective risk factors for intestinal necrosis based on computed tomography (CT) findings. From October 2004 to June 2013, data from consecutive patients diagnosed with incarcerated OH at Kameda Medical Center were collected. All patients underwent laparotomy and were classified into either the viable group (no incarceration-related intestinal damage) or the necrosis group (incarceration-related intestinal damage present). Patient characteristics and CT findings were retrieved retrospectively, including incarcerated intestine length, obturator canal width, and precise location of incarceration. Multivariate logistic regression with backward elimination was performed to identify risk factors for intestinal necrosis. A total of 37 patients were included, with 25 in the viable group and 12 in the necrosis group. Multivariate analysis revealed that increased incarcerated intestine length on CT was significantly associated with necrosis (p = 0.004; odds ratio, 1.19 per 1-mm increase; 95% confidence interval, 1.06-1.34), outweighing other factors such as white blood cell count, C-reactive protein levels, and time from onset to hospital arrival. Length of the incarcerated small bowel on CT may be a potential risk factor for intestinal necrosis in patients with OH.

BN SO46 - PANDORA's BOX- When anatomy trumps the pathology

Abstract Background Obturator hernias are usually attributed to elderly females presenting with small bowel obstruction. We present a case of an elderly gentleman with severe Kyphoscoliosis presenting with small bowel obstruction. His past medical history included Ischaemic Heart Disease with stents in the coronary arteries and on dual antiplatelets. His Kyphoscoliosis precluded him from being able to lie flat on his back. The spinal deformity as revealed in the CT scans proved challenging to position him dsafely for surgery. The lack of access between costal margins and the pelvis meant that surgical access with Laparoscopy was going to be impossible. Method After initial resuscitation, he underwent CT scan of his Chest, abdomen and pelvis which revealed an obstructed Obturator Hernia on the left side with small bowel obstruction. The CT was also concerning for the Anaesthetists due to the challenge posed by the severe Kyphoscoliosis. After fibreoptic intubation, abdomen was accessed through a transverse muscle cutting incision, at the level of the umbilicus. The Obturator membrane was approached from above and the hernia was reduced. The obstructed small bowel was viable and the defect in the obturator membrane was closed with No1 Ethibond sutures. The abdomen was closed with mass closure. Results Patient had a smooth post operative period and was discharged home after 2 weeks. Obturator hernias are notorious for their occult presentation. Unless the patient is scanned with CT imaging, it is impossible to make the diagnosis although clinical signs like Howship- Romberg sign may be present with pain on internal rotation of the hip, as a result of irritation of the Obturator nerve. Obturator Neuralgia may be elicited with positive Hannington- Kiff sign, which is an absence of absent adductor reflux in the thigh. Conclusion Obturator hernias are typically seen in skinny old females. When presenting with small bowel obstruction, Obturator herniae are challenging both in terms of diagnosis as well as in management. In our case, the challenging anatomy posed greater risk to safe airway control. From surgical view, laparoscopy as a less invasive option was ruled out because of the restricted access. When anatomy is challenging, the Surgeon will be forced to think outside the box and consider access to the abdomen through incisions which are not routinely used. The preoperative imaging shows the challenge posed by the extreme spinal deformity.

A Case Report of Obturator Hernia: Surgical Management of a Rare Scenario in a Tertiary Care Hospital of North Eastern India

A Case Report of Obturator Hernia: Surgical Management of a Rare Scenario in a Tertiary Care Hospital of North Eastern India

Diagnosis and surgical treatment of obturator hernia in the recent decade with long-term follow-up: A single center experience.

Obturator hernia (OH) is a rare and dangerous disease that can lead to life-threatening consequences, and pelvic computed tomography (CT) is widely used for its diagnosis. There is no consensus regarding the surgical approach and repair methods. Retrospective analysis of the clinical and follow-up data of 15 cases of incarcerated hernias patients admitted to the Department of General Surgery, affiliated to Taicang Affiliated Hospital of Soochow University, from January 2011 to December 2022. OH could be precisely diagnosed with pelvic CT scan, except for occult OH and non-strangulated OH. Thirteen patients underwent emergency surgery, with a total complication rate of 76.9% and no mortality. Ten patients underwent open surgery, and 3 patients underwent laparoscopic surgery, which had advantages in terms of total cost and postoperative hospital stay (P < .05). Emergency patients all underwent simple peritoneal closure, and hernial sac excision was simultaneously performed in 6 of them. A recurrence (7.7%) was detected at 38 months after the first operation. There was no statistically significant difference between the 2 tissue repair methods in terms of recurrent rate. Pelvic CT can be used as a gold standard for the diagnosis of incarcerated OH, but it has limited value in occult OH and non-strangulated OH. Laparoscopic surgery is recommended for patients with a short onset time and no abdominal physical signs. Tissue repair is sufficient for incarcerated OH and hernial sac excision may be unnecessary.

Clinical analysis of 18 cases of obturator hernia

Abstract Introduction: Obturator hernia is a relatively rare type of abdominal external hernia. The diagnosis is often delayed because of its rarity and nonsepcific symptoms and signs. Patients and Methods: Retrospective study of 18 patients undergoing surgery for obturator hernia in a 11-year period. Results: 15 female and 3 male patients were recorded. Low body mass index (BMI) was the common predisposing factor. Accurate preliminary diagnosis were made only in 8 patients with support of timely computed tomography (CT) scans. The rate of strangulated hernias was 33.33% (6/18)and intestinal resection was required in 4 cases. 11 patients underwent open surgery while 7 received laparoscopic surgery. Simple closure of the hernia defect or hight ligation was performed in 12, mesh repair in 6. No serious operative complications was observed. Conclusions: Obturator hernia should be included in the differential diagnosis of intestinal obstruction of unknown origin, especially in elderly women with low BMI. Early surgical intervention is imperative to avoid intestinal resection and reduce complications. Laparoscopy has a tendency to rapid recovery but has its limits.

Leg Pain—An Unexpected Twist

Leg Pain—An Unexpected Twist

Time to symptom onset and manual reduction outcomes as predictors of bowel viability in incarcerated obturator hernias

The current study aimed to identify the indications for manual reduction in incarcerated obturator hernias (OH). Further, whether time to symptom onset and manual reduction outcomes can be predictors of bowel viability and the need for bowel resection in incarcerated OH were examined. This retrospective study included 26 patients with incarcerated OH who underwent surgery. All patients underwent manual reduction, and computed tomography scan after manual reduction confirmed hernia release. Multivariate analyses were performed to determine the predictors of bowel resection. The bowel resection group had a significantly longer average time to symptom onset than the nonbowel resection group (88 vs 36 h). Further, the bowel resection group was more likely to have failed manual reduction than the nonbowel resection group. A time to symptom onset of ≥ 72 h and failed manual reduction were significant predictors of bowel viability. Age, sex, hernia localization, American Society of Anesthesiologists physical status score, and laboratory findings did not differ significantly between the bowel resection and nonbowel resection groups. Time to symptom onset and manual reduction outcomes are significant predictors of bowel viability in incarcerated OH. Patients with a time to symptom onset of ≥ 72 h and failed manual reduction require surgical evaluation due to a high risk of bowel nonviability. Therefore, a cautious approach is required in the management of OH, and further research on optimized treatment protocols should be conducted.