A New Repositioning Maneuver for Incarcerated Obturator Hernia

Kamihata, Kyohei; Nagahisa, Yoshio; Togawa, Yuki; Muto, Jun; Hashida, Kazuki; Yokota, Mitsuru; Yamaguchi, Kazushige; Okabe, Masaru; Kitagawa, Hirohisa; Kawamoto, Kazuyuki

doi:10.5833/jjgs.2020.0169

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Subsequently, manual reduction was performed by compressing the posterior side of the adductor longus muscle and the lateral side of the labium majus manually until the hypoechoic mass disappeared. If the incarcerated hernia was not released promptly, the surgeon’s assistant bent and stretched the patient’s leg repeatedly 3 , 4 , 10 . Thereafter, the patient underwent CT scan to confirm the release of the hernia and the absence of perforation.…”

Section: Methodsmentioning

confidence: 99%

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

Gokon,

Ohki,

Ogino

et al. 2024

Sci Rep

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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.

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Section: Methodsmentioning

confidence: 99%

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

Gokon,

Ohki,

Ogino

et al. 2024

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Subsequently, manual reduction was performed by compressing the posterior side of the adductor longus muscle and lateral side of the labium majora manually, until the hypoechoic mass disappeared. If the incarcerated hernia is not released promptly, the assistant bends and stretches the patient’s leg repeatedly 3 , 4 , 7 . After the maneuver, the patient underwent a CT scan to confirm the release of the hernia and the absence of perforation (Fig.…”

Section: Methodsmentioning

confidence: 99%

Manual reduction for incarcerated obturator hernia

Gokon

Ohki

Ogino

et al. 2023

Sci Rep

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Emergent surgery is a common approach for incarcerated obturator hernias, with high morbidity and mortality rates. Moreover, there have been reports of elective surgery cases after noninvasive manual reduction. For a decade, the initial approach in our institution is also manual reduction unless bowel viability is poor. This study aimed to clarify the efficacy and safety of manual reduction followed by elective surgery. We retrospectively reviewed 50 cases of incarcerated obturator hernia from 2010 to 2022 at Iwate Prefectural Iwai Hospital. Manual reduction was attempted in 31 (62%) patients. The reduction was successful in 21 (42%) patients, and most of them received mesh repair using the extraperitoneal approach as elective surgery. However, two patients underwent emergent surgery in the waiting period because of late-onset constriction and a small bowel perforation. Patients with irreducible hernia underwent emergent surgery, except for two patients who received the best supportive care. Postoperative complications were observed in 5% and 22% of reducible and irreducible cases, respectively. Postoperative mortality was zero in both groups. Manual reduction is useful in some cases, but careful observation is needed because late-onset constriction and perforation could occur.

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“…Therefore, until recently, there has been no controversy regarding whether manual reduction (with or without elective surgery) or emergency surgery was more effective. Kamihata et al [ 12 ] described a new repositioning maneuver for incarcerated obturator hernia called 4-hand reduction for obturator hernia with the guidance of sonography (FROGS) in Japan. This simple technique was created based on previous reports to treat obturator hernias in the emergency department.…”

Section: Introductionmentioning

confidence: 99%

“…To the best of our knowledge, this is the first report to statistically demonstrate the efficacy of a noninvasive manual reduction technique, FROGS, as a new treatment strategy for obturator hernias and includes 6 more cases than the previous study. [12] 2. Methods…”

Section: Introductionmentioning

confidence: 99%

Evaluation of 4-hand reduction for obturator hernia with the guidance of sonography as a new treatment strategy: A retrospective study

Togawa

Kamihata²,

Nagahisa

et al. 2022

Medicine

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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.

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A New Repositioning Maneuver for Incarcerated Obturator Hernia

Cited by 4 publications

References 23 publications

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

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

Manual reduction for incarcerated obturator hernia

Evaluation of 4-hand reduction for obturator hernia with the guidance of sonography as a new treatment strategy: A retrospective study

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