Laparoscopic transabdominal preperitoneal hernioplasty for recurrent obturator hernia: A case report

Abstract

Reports of recurrence after obturator hernia repair are few. We describe the case of an 89‐year‐old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non‐mesh repair twice and then laparoscopic non‐mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.

Laparoscopic transabdominal preperitoneal repair for recurrent obturator hernia initially treated by open mesh plug repair: A case report with video

“…Intestinal distension secondary to obstruction makes it harder to prepare the operative field to dissect adhesive tissue around the obturator canal. 3 Therefore, its indication is limited to cases that might have a suitable operative field, such as TAPP following manual reduction 3,7 or two-stage TAPP. 10 In our institution, open hernioplasty is performed for OH when manual reduction is not applicable.…”

“…Amiki et al performed TAPP for recurrent OH initially treated with non-mesh repair, and they noted that TAPP approach can be used in cases with severe adhesion around the peritoneum better than other approaches. 7 This is because the laparoscopic view enables the direct observation of the peritoneal cavity. In our case, the patient was previously treated with mesh plug repair, and suturing of the mesh with the Cooper ligament caused strong adhesions around the obturator canal.…”

“…However, reports of laparoscopic repair for recurrent OH are limited. Amiki et al performed TAPP for recurrent OH initially treated with non‐mesh repair, and they noted that TAPP approach can be used in cases with severe adhesion around the peritoneum better than other approaches. 7 This is because the laparoscopic view enables the direct observation of the peritoneal cavity.…”

Laparoscopic Treatment of Complicated Obturator Hernia: A Case Series of 6 Patients

“…Obturator hernia (OH), a consequence of the weakness of obturator membrane, is known as “little old lady's hernia.” [1] It is a rare disease, accounting for 0.7% to 1% of all hernias and 0.2% to 1% of causes of mechanical bowel obstruction. [2] Preoperative diagnosis is challenging because of nonspecific signs and symptoms, thus leading to delayed diagnosis and potentially fatal complications including bowel ischemia and necrosis requiring segmental resection of the affected bowel.…”