Manual reduction for incarcerated obturator hernia

Gokon, Yusuke; Ohki, Yoshimichi; Ogino, Tomoaki; Hatoyama, Keiichiro; Oikawa, Takahiro; Shimizu, Kenji; Katsura, Koji; Abe, Takayuki; Sato, Koichiro

doi:10.1038/s41598-023-31634-4

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…Our previous study examined reduction techniques for OH 6 . However, the current study investigated the bowel viability predictors, which focused on factors such as time to symptom onset and outcomes of manual reduction.…”

Section: Discussionmentioning

confidence: 99%

“…All patients were diagnosed with incarcerated OH on computed tomography (CT) scans. Manual reduction was the initial approach for incarcerated OH, followed by elective surgery after approximately 1 month 6 . If the hernia was irreducible, emergent surgery was performed.…”

Section: Methodsmentioning

confidence: 99%

“…All patients underwent ultrasound-guided manual reduction of OH 6 . The patients were placed in the supine position with the leg in abduction, flexion, and external rotation.…”

Section: Methodsmentioning

confidence: 99%

“…Manual reduction is the initial approach for incarcerated OH, followed by elective surgery, at our institution. Previous research has reported the usefulness of manual reduction for incarcerated OH 6 . However, a consensus regarding the indications for manual reduction in incarcerated OH has not been established 5 .…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…All patients underwent ultrasound-guided manual reduction of OH 6 . The patients were placed in the supine position with the leg in abduction, flexion, and external rotation.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Self Cite

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The impact of non-invasive manual and ultrasonographic reduction for incarcerated obturator hernia: a retrospective cohort study and systematic review

Kobayashi,

Watanabe,

Koizumi

et al. 2024

Hernia

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Purpose Non-invasive reduction in patients with incarcerated obturator hernias is an emergency surgery alternative. There are two non-invasive reduction types: manual and ultrasonographic (ultrasound-guided and ultrasound-assisted reduction). However, the impact of ultrasound guidance on manual reduction has not been adequately evaluated. We aimed to compare non-invasive ultrasound reduction with manual reduction in patients with incarcerated obturator hernias. Methods We searched MEDLINE, Cochrane Central Library, Embase, Ichushi Web, ClinicalTrial.gov, and ICTRP for relevant studies. The primary outcomes were success and bowel resection rates. We performed a subgroup analysis between ultrasound-guided and ultrasound-assisted reductions. This study was registered in PROSPERO (CRD 42,024,498,295). Results We included six studies (112 patients, including 12 from our cohort). The success rate was 78% (69 of 88 cases) with ultrasonographic reduction and 33% (8 of 24 cases) with manual reduction. The success rate was higher with ultrasonographic than with manual reduction. Subgroup analysis revealed no significant difference between ultrasonography-assisted (76%) and ultrasonography-guided (80%) reductions (p = 0.60). Non-invasive reductions were predominantly successful within 72 h of onset, although durations extended up to 216 h in one case. Among the successful reduction cases, emergency surgery and bowel resection were necessary in two cases after 72 h from onset. Bowel resection was required in 48% (12 of 25), where the non-invasive reduction was unsuccessful within 72 h of confirmed onset. Conclusions Ultrasonographic reduction can be a primary treatment option for patients with obturator hernias within 72 h of onset by emergency physicians and surgeons on call. Future prospective studies are needed to evaluate ultrasonographic reduction’s impact.

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Total and Simultaneous Coverage Repair for the Obturator Hernia and Groin Hernias With One Large Mesh: A Case Report

Urade,

Maruzen,

Terakawa

2024

Cureus

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Obturator hernia is a rare condition. Preoperative diagnosis is difficult to achieve because the hernia swelling is rarely palpable. Diagnosis is often delayed, and the hernia can become fatal if intestinal strangulation occurs, especially in older patients. Hesitation in the intervention will result in perforation, peritonitis, sepsis, and death. We herein report a case involving a Japanese woman in her 90s who visited our emergency room with nausea and right inner thigh pain. Computed tomography (CT) at onset revealed intestinal incarceration between the piriformis and external obturator muscles; therefore, a right-sided obturator hernia was diagnosed. Manual release of the incarceration, combined with echo probe manipulation and lower extremity movement, was successfully performed. The patient’s pain was dramatically reduced, and emergency surgery was avoided. A prompt hernia release after reaching the correct diagnosis is very important for obturator hernia patients. Scheduled minimally invasive surgery (transabdominal pre-peritoneal repair, TAPP) was subsequently performed. Intraoperatively, a coexistence of ipsilateral femoral hernia was detected by laparoscope. Therefore, we tried to cover not only the obturator canal but also the subclinical coexistence of ipsilateral groin hernias. All four hernia orifices (obturator hernia orifice, internal inguinal hernia orifice, external inguinal hernia orifice, and femoral hernia orifice) were covered at the same time with a single large mesh of 15 × 10 cm. Reports detailing such approaches (total and simultaneous coverage of the obturator canal and myopectineal orifice with one rectangular mesh) are relatively rare in the literature.

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Manual reduction for incarcerated obturator hernia

Cited by 3 publications

References 12 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

The impact of non-invasive manual and ultrasonographic reduction for incarcerated obturator hernia: a retrospective cohort study and systematic review

Total and Simultaneous Coverage Repair for the Obturator Hernia and Groin Hernias With One Large Mesh: A Case Report

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