To evaluate the effectiveness of 4-hand reduction for obturator hernia with the guidance of sonography (FROGS) as a new treatment strategy for obturator hernia. Since November 2019, FROGS was performed for all patients with obturator hernia at our emergency department. We retrospectively compared the clinical data of 20 patients who underwent FROGS (after FROGS group) to those of 23 patients who did not (before FROGS group). All patients except one were female. The male-to-female ratio, age, duration of symptoms, lesion site, and predisposing factors did not significantly differ between groups. However, the diameter of the prolapsed bowel and the body mass index of the after FROGS group were significantly larger and lower, respectively. Manual reduction was successfully performed for all 20 patients in the after FROGS group, and bowel resection was avoided for all 20 cases. However, 14 patients in the before FROGS group underwent manual reduction; of these, only one was successfully treated using a method other than FROGS, and 8 patients underwent bowel resection. There were no significant differences between groups in terms of postprocedural complications or mortality within 30 days of hernia presentation. The FROGS technique was safe and reproducible and could be used as the first choice of treatment for patients with obturator hernia.
Background Obturator hernia is an uncommon but important cause of intestinal obstruction. Delayed treatment can be fatal. Emergency surgery is considered the most effective treatment; however, patients with obturator hernia usually have comorbidities, which precludes them from emergency surgery. This study aimed to evaluate the effectiveness of Four-hand Reduction for Obturator hernia with the Guidance of Sonography (FROGS) as a new treatment strategy for obturator hernia. Methods Since November 2019, we have tried FROGS in all patients with obturator hernia at the emergency room. All the patients were female. We retrospectively compared the clinical data of 14 patients who underwent FROGS (after-FROGS group) with those of 23 patients who did not (before-FROGS group). Results No significant differences were observed in age, lesion side, duration of symptoms, the diameter of the prolapsed bowel, and predisposing factors. The body mass index was significantly lower in the after-FROGS group than in the before-FROGS group. Manual reduction was successfully performed in all 14 patients in the FROGS group, whereas in the before-FROGS group, 14 patients underwent manual reduction, of whom only one was successfully treated using the non-FROGS method. Bowel resection was avoided in all 14 patients in the after-FROGS group, whereas 8 patients underwent bowel resection in the before-FROGS group. There were no significant differences in postoperative complications and mortality within 30 days after hernia presentation between the two groups. Conclusion Manual reduction with FROGS was found to be safe and reproducible and can be the first treatment choice for obturator hernia.
Background Obturator hernias are uncommon but are important causes of intestinal obstruction. Delayed treatment can be fatal. Emergency surgery is considered the most effective treatment; however, patients with obturator hernia usually have comorbidities, and this precludes them from emergency surgery. Previously, a few case studies reported successful manual reductions for an incarcerated obturator hernia. However, their efficacy was not statistically confirmed. We have devised a new manual reduction method for an incarcerated obturator hernia based on previous studies. We have named this method “Four-hand Reduction for Obturator hernia with the Guidance of Sonography” (FROGS). This study aimed to evaluate the effectiveness of FROGS as a new treatment strategy for obturator hernia. Methods Since November 2019, we have tried FROGS in all patients with obturator hernia at the emergency room. We retrospectively compared the clinical data of 14 patients who underwent FROGS (after-FROGS group) with those of 23 patients who did not (before-FROGS group). Results All patients were females. There were no significant differences in age, lesion side, duration of symptoms, the diameter of the prolapsed bowel, and predisposing factors. The body mass index was significantly lower in the after-FROGS group than in the before-FROGS group. Manual reduction was successfully performed in all 14 patients in the FROGS group, whereas in the before-FROGS group, 14 patients underwent manual reduction, of whom only one was successfully treated using the non-FROGS method. Bowel resection was avoided in all 14 patients in the after-FROGS group, whereas 8 patients underwent bowel resection in the before-FROGS group. There were no significant differences in postoperative complications and mortality within 30 days after hernia presentation between the two groups. Conclusion Manual reduction using the FROGS technique was found to be safe and reproducible and can be the first treatment choice for patients with obturator hernia.
Purpose: Obturator hernias are uncommon but are important causes of intestinal obstruction. Delayed treatment can be fatal. Emergency surgery is considered the most effective treatment; however, patients with obturator hernia usually have comorbidities, and this precludes them from emergency surgery. This study aimed to evaluate the effectiveness of Four-hand Reduction for Obturator hernia with the Guidance of Sonography (FROGS) as a new treatment strategy for obturator hernia.Methods: Since November 2019, we have tried FROGS in all patients with obturator hernia at the emergency room. We retrospectively compared the clinical data of 14 patients who underwent FROGS (after-FROGS group) with those of 23 patients who did not (before-FROGS group).Results: All patients were females. There were no significant differences in age, lesion side, duration of symptoms, the diameter of the prolapsed bowel, and predisposing factors. The body mass index was significantly lower in the after-FROGS group than in the before-FROGS group. Manual reduction was successfully performed in all 14 patients in the FROGS group, whereas in the before-FROGS group, 14 patients underwent manual reduction, of whom only one was successfully treated using the non-FROGS method. Bowel resection was avoided in all 14 patients in the after-FROGS group, whereas 8 patients underwent bowel resection in the before-FROGS group. There were no significant differences in postoperative complications and mortality within 30 days after hernia presentation between the two groups.Conclusion: Manual reduction using the FROGS technique was found to be safe and reproducible and can be the first treatment choice for patients with obturator hernia.
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