Laparoscopic treatment of a strangulated obturator hernia

Hernia through the obturator canal is usually unsuspected and hence undiagnosed. Patients with obturator hernias present as acute cases of intestinal obstruction secondary to strangulation or incarceration, with high rate of morbidity and mortality due to delayed diagnosis and treatment. The know incidence of obturator hernia is low, representing 0.073% (11 of 15,098) of all hernias repaired at the Mayo Clinic in a retrospective study of 15 years. In this study, we conducted a retrospective analysis of laparoscopic extraperitoneal hernia repairs that were performed between the years 2003 and 2007. All procedures were undertaken by 2 experienced surgeons who performed more than 150 previous surgeries. In 293 patients who underwent repair of bilateral or recurrent inguinal hernia, exploration of the obturator foramen was conducted looking for obturator hernia, which was found in 20 cases (6.82% of patients). The true incidence of obturator hernia is greater than that reported in the literature, and the chances of detecting hernia are greater if an equal number of men and women are scanned could be higher if pelvic scanning was performed.

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“…Advanced age of the patient and associated chronic diseases result in mortality as high as 47%. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Obturator hernia as a frequent finding during laparoscopic pelvic exploration

Susmallian

Ponomarenko²,

Barnea³

et al. 2016

Medicine

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“…On retrouve dans la littérature un taux d’épisodes sub-occlusifs variant de 11,8 à 34, 7% [ 4 , 6 ], ce qui a été noté chez nos deux patientes. La HO siège le plus souvent du côté droit, associée à une hernie inguinale dans 2,1% des cas [ 7 ], et elle est bilatérale dans 6% des cas. Dans les cas que nous avons rapportés, l'association à une hernie crurale chez la deuxième patiente a fait errer le diagnostic et aboutis à un retard du traitement chirurgical adéquat, qui a probablement été à l'origine du décès.…”

Section: Discussionunclassified

“…Le meilleur argument clinique est le signe de Romberg-Howship. Sa fréquence varie entre 15 et 50% des cas [ 3 , 7 ]. Il correspond à une douleur liée à la compression du nerf obturateur, par le sac herniaire, notamment de sa branche cutanée.…”

Section: Discussionunclassified

Hernie obturatrice étranglée: à propos de deux cas

et al. 2015

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La hernie obturatrice (HO) est rare. Elle est à l'origine de 0,2 à 1,6% des occlusions mécaniques de l'intestin grêle avec un taux de mortalité et morbidité après chirurgie est respectivement de 35 et 18%. Nous rapportons le cas de deux patientes chez qui le diagnostic de HO étranglée est établie dans le cadre du bilan d'une occlusion. La HO est une entité dont le diagnostic préopératoire est difficile en raison de la faible spécificité clinique. L'examen tomodensitométrique semble être une aide majeure au diagnostic étiologique. Mais une fois le diagnostic d'occlusion posé, une intervention en urgence permettra d'en préciser l’étiologie et d'en réaliser le traitement. Tout retard thérapeutique majore la mortalité et la morbidité.

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“…9 Since then, 6 cases have been documented with this approach in emergency situations. [10][11][12][13][14][15] In 1998, Yokoyama et al 16 reported the first case with a preoperative diagnosis undergoing surgery via total extraperitoneal laparoscopy. There are currently 2 other references, published by Shapiro et al 17 and Chowbey et al 18 in 2004; however, in both cases surgery was indicated with a diagnosis of inguinal hernia, and only exploration of the obturator space allowed identification of these hidden hernias.…”

Section: Discussionmentioning

confidence: 99%

Obturator Hernia as a Cause of Chronic Pain After Inguinal Hernioplasty: Elective Management Using Tomography and Ambulatory Total Extraperitoneal Laparoscopy

Moreno-Egea

Calle²,

Ja³

et al. 2006

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Obturator hernia is a rare variety of pelvic hernia. Preoperative diagnosis is still uncommon and influences treatment and prognosis. Clinical suspicion and tomography are fundamental for establishing a preoperative diagnosis. Subsequently, elective treatment via the total extraperitoneal laparoscopic approach seems to offer the best results for both the patient and the hospital. This management might reduce the high rates of associated morbidity and mortality. We present the case of a patient with chronic pelvic pain after hernia surgery in whom tomography confirmed the existence of a bilateral obturator hernia. Details are given of diagnostic and therapeutic management using ambulatory total extraperitoneal laparoscopy. We recommend ruling out obturator hernia as a possible cause of chronic pain after hernia repair.

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Laparoscopic treatment of a strangulated obturator hernia

Cited by 14 publications

References 9 publications

Obturator hernia as a frequent finding during laparoscopic pelvic exploration

Obturator hernia as a frequent finding during laparoscopic pelvic exploration

Hernie obturatrice étranglée: à propos de deux cas

Obturator Hernia as a Cause of Chronic Pain After Inguinal Hernioplasty: Elective Management Using Tomography and Ambulatory Total Extraperitoneal Laparoscopy

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