Obturator Hernia Research Articles

Linea Alba Hernia in Association with Bilateral Obturator and Inguinal Hernias in a Male Patient

Linea Alba Hernia in Association with Bilateral Obturator and Inguinal Hernias in a Male Patient

A Case of Impacted Obturator Hernia Treated by Elective Laparoscopic Repair After Manual Reduction

A Case of Impacted Obturator Hernia Treated by Elective Laparoscopic Repair After Manual Reduction

A Case of Incarcerated Obturator Hernia with Hepatic Portal Venous Gas Treated with Ultrasound-guided Reduction and Elective Surgery

A Case of Incarcerated Obturator Hernia with Hepatic Portal Venous Gas Treated with Ultrasound-guided Reduction and Elective Surgery

Rare Emergency Hernias

Rare forms of hernias can cause diagnostic difficulties that require special modifications of operating methods. Due to their rarity, they may lead to a serious threat to the health and life of patients. We present three patients with unique sudden hernias that may be problematic in clinical practice. We have chosen cases that were urgently operated in our department. The described cases of obturator hernia, Spiegel's hernia and strangulated inguinal hernia containing a bladder in the hernial sac require more attention not only because of their rarity, but above all because of unusual symptoms leading to delayed diagnosis. This may result in a delayed start of treatment and, consequently, an increase in mortality. The surgeon often finds out about the difference of hernia only during the operation, therefore everyone should know the techniques of managing such cases. Medical emergencies included in this paper demonstrate that unique pathologies must remain in the mind of the surgeons and offer a comprehensive review.

A Case of Obturator Hernia Treated by Laparoscopic Hernia Repair after Ultrasound-guided Reduction

A Case of Obturator Hernia Treated by Laparoscopic Hernia Repair after Ultrasound-guided Reduction

Two Cases of Obturator Hernia Repaired by the Direct Kugel Method Using the Inguinal Approach

Two Cases of Obturator Hernia Repaired by the Direct Kugel Method Using the Inguinal Approach

A case report and a contemporary review of incarcerated and strangulated obturator hernia repair

A case report and a contemporary review of incarcerated and strangulated obturator hernia repair

Obturator Hernia: An Unexpected Cause of Small Bowel Obstruction

Obturator hernia is a rare hernia and mostly found in elderly emaciated women. Patients are mostly presented as abdominal pain from small bowel obstruction. Herein, we reported one case of obturator hernia in a patient who presented with dyspnea instead of abdominal pain. Keywords: Dyspnea, Obturator hernia, Small bowel obstruction

Prediction of bowel obstruction caused by obturator hernia using risk factor categories on clinical characteristics and multidetectorcomputed tomographic findings.

To detect risk factors on clinical characteristics and multidetectorcomputed tomographic (MDCT) findings for predicting bowel obstruction in patients with obturator hernia. We retrospectively reviewed 47 patients who had an obturator hernia diagnosed by MDCT and/or surgery. The patients were divided into obstruction and non-obstruction group based on the presence or absence of bowel obstruction on MDCT images. Uni- and multivariate analyses were performed to identify risk factors for predicting bowel obstruction. There were 26 patients (55.32%) in the obstruction group and 21 patients (44.68%) in the non-obstruction group. Patients in the obstruction group were older (P = 0.002) and had more women (P = 0.033) and lower body mass index (BMI) (P = 0.0001) than patients in the non-obstruction group. The non-obstruction group suffered fewer bowel obstruction symptoms (P = 0.0001), Howship-Romberg (HR) sign (P = 0.012), deaths (P = 0.008) and major postoperative complications (P = 0.047). The hernia sac in the obstruction group had greater mean major diameter (P = 0.0001) and volume (P = 0.001) than those in the non-obstruction group. Multivariate analysis showed that age [odds ratio (OR) 1.18, 95% confidence interval (CI) 1.00-1.39, P = 0.046] and major diameter of hernia sac (OR 68.17, 95% CI 4.52-1027.70, P = 0.002) were independent risk factors associated with bowel obstruction in patients with obturator hernia. Patient's age and major diameter of hernia sac are independent risk factors resulting in bowel obstruction in patients with obturator hernia. Obturator hernia repair before bowel obstruction development may result in better outcomes and fewer postoperative complications.

Does preoperative enhanced CT predict requirement of intestinal resection in the patients with incarcerated myopectineal hernias containing small bowel?

Bowel wall enhancement on CT imaging is considered one of the useful features for the prediction of the presence of irreversible ischemic change in patients with small bowel obstruction. However, the applicability of CT imaging in patients with incarcerated hernias has not been investigated in detail. The aim of this retrospective study was to evaluate the feasibility of preoperative CT findings for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel. Included in this study were 76 patients who underwent surgery for preoperatively diagnosed incarcerated hernias containing small bowel (27 inguinal hernias, 37 femoral hernias and 12 obturator hernias) at our hospital between January 2011 and June 2020. The preoperative clinicoradiological features were compared between the groups, and predictors for intestinal resection were evaluated. Nineteen patients required intestinal resection (Resection group), and the other 57 patients did not require intestinal resection (Nonresection group). Multivariate analyses revealed that age ≥ 80years (p = 0.018, odds ratio = 6.604) and the absence of bowel wall enhancement (p = 0.032, odds ratio = 51.200) were independent predictors for intestinal resection. In resected specimens, all patients with an absence of bowel wall enhancement on preoperative enhanced CT had ischemic changes extending beyond the muscularis propria. Preoperative enhancement CT yields useful information for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel.

Obturator hernia: Clinical analysis of 11 patients and review of the literature.

Obturator hernia is a relatively rare type of abdominal hernia, in which abdominal contents protrude through the obturator canal, a condition that can lead to small bowel obstruction. Its rarity and nonspecific signs and symptoms make a preoperative diagnosis difficult. The present study analyzed the clinical manifestations, diagnostic methods and operative treatment outcomes in patients with obturator hernia.Between January 2012 and October 2019, 1028 adults underwent surgical repair of abdominal wall hernia at the Department of Surgery, Kyungpook National University Hospital. The medical records of eleven patients who were treated for small bowel obstruction due to obturator hernia were retrospectively evaluated. Patient characteristics, clinical presentation, preoperative radiological diagnosis, operative findings, treatment, complications, and outcomes were recorded.All 11 patients were elderly women, with a mean age of 80.2 years (range, 71–87 years). Their mean body mass index was 17.9 kg/m2 (range, 11.9–22.2 kg/m2). Symptoms at presentation were abdominal pain and vomiting, with a mean duration of symptoms prior to admission of 5.6 days (range, 1–15 days). Based on abdominopelvic computed tomography (CT) scans, all 11 patients were preoperatively diagnosed with obturator hernia, followed by laparoscopic exploration or laparotomy as soon as possible. Of the 11 patients, 6 (54.5%) had left-sided, four (36.4%) had right-sided, and one (9.1%) had bilateral obturator hernias. Three patients (27.3%) required resection of the ileum due to perforation or strangulation. All underwent simple closure of the hernia defect with interrupted or purse-string sutures. Ten patients recovered uneventfully, whereas one had wound seroma and ileus. Recurrence has not been observed in the 8 surviving patients.Obturator hernia should be included in the differential diagnosis of intestinal obstruction of unknown origin, especially in emaciated elderly women with chronic disease. Early surgical intervention without delay is imperative to avoid postoperative morbidity and mortality associated with intestinal strangulation due to obturator hernia. Obturator hernia can be sufficiently repaired with simple suture closure without mesh.

Obturator hernias: a systematic review of the literature.

Obturator hernias (OH) are extremely rare hernias, accounting for 0.07-1% of all hernias. This is the first systematic review investigating their presentation, imaging, treatment outcomes, and recurrence rate. After a detailed search in electronic search engines, 74 studies matched our criteria. A review of these reports was conducted and the full texts were examined. A total of 146 patients with a mean age of 78.8years were included in our analysis, with 40.1%, 29.9%, and 25.2% of patients suffering from either a right, a left or bilateral OH, respectively. OH were associated with non-specific symptoms and signs; bowel obstruction being the most common. Howship-Romberg sign was present in 56.2% of patients. Computed tomography (CT) scan was the most frequently used diagnostic modality, inversely associated with perioperative mortality. Mesh repair demonstrated a significantly improved perioperative morbidity rate, compared with non-mesh repair. Approximately 30% of patients underwent a laparoscopic operation, which was associated with significantly decreased morbidity and mortality rate as well as length of hospital stay, compared with the open repair. OHs are not associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair.

Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults.

Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of “tension-free repair” is generally accepted, and surgical repairs with mesh are categorized as “hernioplasties”. Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.

Obturator Hernia with Meckel’s Diverticulum Mimicking Incarcerated Small Bowel Hernia: A Case Report

: An obturator hernia is a rare type of abdominal hernia that can cause acute intestinal obstruction. Meckel’s diverticulum, the most common gastrointestinal tract malformation, is an uncommon cause of intestinal obstruction. The combination of obturator hernia and Meckel’s diverticulum is extremely rare. We report a rare case of obturator hernia with Meckel’s diverticulum in a 76-year-old woman who presented at the emergency room with complaints of abdominal pain. The diagnosis was confirmed by a computed tomography (CT) scan and exploratory laparotomy. Since obturator hernia is uncommon and rarely associated with Meckel’s diverticulum, we described the imaging features in this case study.

Which Patients Are a Better Candidate of Laparoscopic Repair in Obturator Hernia Patients?

PurposeObturator hernia is a difficult disease to diagnose. If a surgical treatment is delayed in obturator hernia, a bowel resection may be required due to strangulation. The surgical treatment of this disease is to use a classical laparotomy. Recently, the laparoscopic approach has been reported and reviewed for efficiency. We checked the indicators that determine the most appropriate surgical method according to the patient’s condition.MethodsIn the study, a single-institution, retrospective analysis of surgical patients undergoing an obturator hernia surgery between 2003 and 2018 was performed. The patients were divided into a laparoscopic group (5 patients underwent laparoscopic repair; no intestinal resection) and an open group (13 patients who underwent open repair; 10 with and 3 without intestinal resection). The outcomes were compared between the groups. We analyzed the relevant factors that could predict the proper method of surgery.ResultsA total 18 patients were included in the study. All patients were female, with body mass index (BMI) of under 21 kg/m2. Of the various factors, only the WBC and CRP counts were the factors that had shown significant differences between the two groups. It is noted that patients with open surgery had a higher WBC counts (10406 versus 6520/μl; p=0.011) and CRP counts (7.84 vs. 0.32 mg/dl; p=0.027).ConclusionObturator hernia can be treated with a laparoscopic surgery. The choice of surgical treatment can be considered in advance through the review of the patient’s WBC count or CRP count.

Treatment outcomes of Kugel repair for obturator hernias: a retrospective study

BackgroundWe examined the validity and applicability of the Kugel repair approach for obturator hernias, whereby we placed a Kugel patch through the preperitoneal space after placing a short 5-cm skin incision just medial to the anterior iliac spine and 2 cm cranial to the expected origin of the internal inguinal ring.MethodsWe studied patients who underwent surgical Kugel repair for obturator hernias at the Department of General Surgery, Saitama Medical University between 2007 and 2017. We examined the operating time, length of hospital stay, postoperative complications, and mortality rate.ResultsFifty-eight patients with obturator hernias presented with symptoms of small bowel obstruction. A Kugel approach was used in 53 patients and a midline approach was used in 5 patients with preoperative peritonitis. Of the 53 patients managed using the Kugel approach, 39 did not require intestinal resection; a mesh was used in all these patients. In the remaining 14 patients, intestinal resection was required and performed using the same approach; subsequently, a mesh was used successfully in 6 of these 14 patients. The overall median operating time was 47 min; the corresponding values for procedures with and without intestinal resection were 39 and 68 min, respectively. In terms of postoperative complications, operative mortality was not noted among patients without intestinal perforation; however, superficial surgical site infection developed in 2 patients. Among the 5 patients with preoperative peritonitis who underwent exploratory laparotomy via a midline incision, intestinal perforation was detected during surgery, and all patients required intestinal resection; none of the patients had received a mesh, and 2 patients died after surgery.ConclusionsThe Kugel repair approach was possible even in patients with obturator hernia requiring intestinal resection. However, for patients with perforations, open surgery should be performed after securing the surgical field through a midline incision.

A new technique to avoid unintentional adhesion while deploying ProGrip mesh and its utility in the laparoscopic repair of obturator hernia.

The ProGrip™ laparoscopic self-fixating mesh provides advantages such as low cost and reduced pain following tack-free fixation in laparoscopic hernia repair through a transabdominal preperitoneal approach. Obturator hernia repair needs adequate fixation around the hernial orifice without the use of tacking, and ProGrip™ mesh provides options for secure fixation. However, it is often difficult to adequately adjust the mesh placement to cover the obturator hernia orifice with a ProGrip™ mesh, due to adhesion of the grips to the surrounding tissues. We introduce our technique to avoid unintentional adhesion during ProGrip mesh repair and discuss its utility in the treatment of obturator hernias. We repaired seven obturator hernia lesions in five patients using this technique without any complications. The biggest advantage of our technique is that the position of the mesh can be adjusted after it is expanded, unless the sheet is completely removed, allowing the surgeons to fix the mesh without any unintended adhesion to surrounding tissue.

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

Prognostic Factors in Obturator Hernia

Objective: Obturator hernia is a rare type of hernia that can occur in the octogenarian patients. We discuss the diagnosis, treatment and management of patients with obturator hernia, and describe the clinical presentation, laboratory and radiological findings. Material and methods: A retrospective study was performed in ten patients diagnosed with an obturator hernia between December 2008 - 2019 at a single tertiary hospital. Patients’ demographic features, clinical symptoms, laboratory and imaging data, comorbidities, surgical treatment methods, postoperative morbidity and mortalities were evaluated. Results: The patients’ mean age was 84.4 years (range between 81 - 89 years). All patients presented with symptoms of small bowel obstructions; abdominal pain located in the lower quadrant (100%), vomiting (60%), nausea (80%) and distension (60%). All patients had air-fluid levels on X-ray. We performed small intestine resection and an end to end anastomosis in four patients, resection with ileostomy in two patients and bowel reduction in four patients. Postoperatively, an anastomosis leak occurred in two patients, they were re-operated and an ileostomy was performed. In the post-op period, six patients died, and four patients survived. Conclusion: Obturator hernia is seen in octogenarian patients with symptoms of small bowel obstruction. The diagnosis is based mostly on computed tomography findings. An elevated neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and lactate levels can be used as a biomarker for the prediction of non-viable small bowel in these OH patients.

Laparoscopic total extraperitoneal obturator hernia repair in critical challenging patients

AIM AND PERSPECTIVE: Obturator hernia is an uncommon surgical disease, a condition predominantly affected the elderly, emaciated, female patients. Various surgical procedures have been used to treat this disease, including open and laparoscopic approaches; however, in some special conditions, the technique is still challenging. METHODS: The technique details of total extraperitoneal (TEP) repair in the treatment of obturator hernia in critical challenging conditions were described. RESULTS: The challenging obturator patients had high risk of comorbidities, including massive ascites, partial intestinal obstruction, malnutrition, and previous abdominal surgeries. All the procedures were successful; patients had no modality and recurrences and chronic pain. One patient developed wound dehiscence and healed with bedside suture. CONCLUSION: The present report justifies the feasibility of TEP obturator hernia repair in challenging conditions.