A new technique of laparoscopic obturator hernia repair: Report of a case

Abstract

An 84-year-old woman presented with ileus. Ultrasonography, a computed tomography scan, and small bowel contrast examination showed a Richter-type hernia in her left obturator orifice. Under general anesthesia, laparoscopic surgery with low-pressure (4mmHg) pneumoperitoneum was carried out using a peritoneal needle retractor, and a reduction of the strangulated intestinal loop was thus achieved. Because the hernial opening measured 5mm in diameter, it could be closed with four pieces of End-Universal stapler without polypropylene mesh. The ischemic ileum was resected, and the bowel was anastomosed extracorporeally with a minimal skin incision. She was ambulant on the first postoperative day, and her postoperative course was good. Obturator hernias are rare, but when a definitive diagnosis is made in such elderly patients, laparoscopic repair using the peritoneal needle retractor is recommended for minimally invasive surgery. We recommend doing the repair with an End-Universal stapler, since this procedure is more simple and useful for preventing infection than using polypropylene mesh in such a strangulated case.

Obturator hernia: embryology, anatomy, surgery

“…Persson et al [1987], Carriquiry and Pifieyro [1988], and Hall et al [199o] have used herniography with success. Ultrasonography has also proven an effective diagnostic tool [Yokoyama 1997, Miki 1998]. …”

Laparoscopic obturator hernia repair in an adolescent

“…Maharaj et al [1] also suggest a primary closure using a patch of peritoneum approximately 10 cm from the defect, which is pulled over the opening in the obturator canal. The use of laparoscopically placed staples without the need for mesh was described by Miki et al [8] to lessen the risk for infection. The use of synthetic patches and plugs for obturator hernia repair has been described as well.…”

Elective plug repair of an incarcerated obturator hernia by the thigh approach after noninvasive manual reduction: Report of two cases

“…1-3 Recent reports describe less-invasive therapeutic strategies, such as elective surgery following noninvasive manual reduction, 5,6 or nonlaparotomy operation, inguinal repair, a preperitoneal approach, 7-9 and laparoscopic repair. 10 The inguinal and preperitoneal repairs are more familiar approaches for most surgeons, who can open the peritoneal cavity easily if required. On the other hand, laparoscopic operations are considered less invasive and also give a direct view of the peritoneal cavity; however, advanced operative techniques are needed, although these patients receive the clinical benefi t of avoiding invasive therapy.…”

“…4 Recently some less-invasive therapeutic attempts have been reported, such as noninvasive manual reduction for incarceration 5,6 or nonlaparotomy repair techniques. [7][8][9][10] We describe how we performed elective plug repair via a thigh approach after noninvasive manual reduction of an incarcerated obturator hernia in two patients. To our knowledge, this is the fi rst report of this novel therapeutic strategy for an incarcerated obturator hernia; namely, noninvasive manual reduction followed by elective plug repair via the thigh, which is extremely effective for selected patients.…”