Obturator hernias: A review of the laparoscopic approach

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Abstract

BACKGROUND:

Obturator hernias (OH) account for a rare presentation to the surgical unit usually associated with bowel obstruction and strangulation. The treatment of this condition is classical laparotomy with repair of the hernia and bowel resection, if deemed necessary; recently, the laparoscopic approach has been reported in literature. This review examines the existing evidence of the safety and effectiveness of the laparoscopic approach for the management of OH.

MATERIALS AND METHODS:

We have conducted a systematic review of the cases reported in the literature between 1991 and 2009, using Medline with PubMed as the search engine, as well as Ovid, Embase, Cochrane Collaboration and Google Scholar databases to identify articles in English language reporting on laparoscopic management for the treatment of this condition.

RESULTS:

A total of 17 articles reporting on 28 cases were found. We describe the pooled data for demographics, operative time, hospital stay, morbidities and method of repair. We also compare to the results of the laparoscopic repair of other types of hernias in the literature.

CONCLUSION:

This approach was found to be a safe and effective approach for the repair of OH as compared to the classical open approach; however, its adoption as the gold standard needs further multicenter trials.

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Most cited references 25

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Obturator hernia: diagnosis and treatment in the modern era.

Sally Mak, S K Mantoo, Oon T. Tan (2009)

Obturator hernia is a rare variety of abdominal hernia that nonetheless is a significant cause of morbidity and mortality, especially in the elderly age group. This article aimed to review the diagnosis and management of obturator hernia by describing the anatomy, clinical presentation, predisposing factors, diagnostic modalities and management in the modern era. We managed six cases of obturator hernia between 2003 and 2006. Five out of six cases were diagnosed by a preoperative computed tomography (CT) and the sixth case was diagnosed by ultrasonography. All except one were managed by an exploratory laparotomy and repair of the hernia, and one was treated with laparoscopic repair. Correct preoperative diagnosis was made in five out of five (100 percent) patients by clinical signs and CT of the abdomen and pelvis, and the sixth patient was operated on the basis of an ultrasonographical diagnosis and strong clinical suspicion. We conclude that the rapid evaluation by CT of the abdomen and pelvis and surgical intervention are possible, thereby reducing the morbidity and mortality of patients with obturator hernia. An algorithm for the management of obturator hernia is proposed.

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Thirty-six cases of obturator hernia: does computed tomography contribute to postoperative outcome?

M. Isogai, Y. Yokoyama, A Hori … (1999)

Obturator hernia is relatively rare and occurs mostly in elderly, thin, multiparous women. Recent reports have highlighted the importance of pelvic computed tomography (CT) for the preoperative diagnosis. Thirty-six patients with an obturator hernia operated in our hospital were divided retrospectively into two groups (group A: 18 operations from 1973 to 1986, before we used CT; group B: 18 CT cases from 1987 to 1995). Preoperative diagnoses, operative procedures, and postoperative course were reviewed. No statistically significant differences were found between groups A and B in terms of patient characteristics. Rates of accurate preoperative diagnoses were significantly higher in group B: 39% (7/18) in group A and 78% (14/18) in group B (p = 0.018). The intraoperative findings, occurrence of postoperative complications, and overall mortality rates were similar between the two groups. There were four postoperative deaths (mortality rate 11%). Three of four patients who died had panperitonitis because of small bowel perforation. The correct preoperative diagnosis of obturator hernia was facilitated by CT of the pelvis, but it has no impact on patient outcome. Early diagnosis and surgical intervention are essential for this rare entity.

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A review of obturator hernia and a proposed algorithm for its diagnosis and treatment.

Yan-Shen Shan, Shen-Shong Chang, Chan-Pin Lin … (2005)

The aim of this article is to provide a review of six patients with the various stages of obturator hernia and a diagnostic and therapeutic strategy in suspected cases. Obturator hernia is relatively rare and is a diagnostic challenge. It is a significant cause of intestinal obstruction, especially in emaciated elderly women with chronic disease. A palpable groin mass is not common in these patients because the hernia mass is usually concealed beneath the pectineus muscle. The high mortality is directly related to the delayed recognition, with resultant ruptured gangrenous bowel, and to the high incidence of patients with concurrent medical illness. A total of six patients with obturator hernias were treated at this hospital between 1994 and 2004, and one of these patients was diagnosed and treated by elective laparoscopy. We reviewed these six cases and examined the clinical presentation, age, body weight, associated medical conditions, preoperative diagnosis, operative findings, complications, and outcome in this retrospective study. We concluded that we cannot shorten the time from onset of symptoms to admission, but what we can do is to make a rapid evaluation and surgical intervention to reduce the morbidity and mortality from obturator hernia. The approaches to different presentation of obturator hernia and diagnostic role of CT scan are also discussed.

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Author and article information

Journal

Journal ID (nlm-ta): J Minim Access Surg

Journal ID (publisher-id): JMAS

Title: Journal of Minimal Access Surgery

Publisher: Medknow Publications (India )

ISSN (Print): 0972-9941

ISSN (Electronic): 1998-3921

Publication date (Print): Oct-Dec 2011

Volume: 7

Issue: 4

Pages: 201-204

Affiliations

[1]Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Praed Street, W2 1NY, UK

Author notes

Address for correspondence: Dr. Emmanouil Zacharakis, Department of Surgery, Division of Surgery and Cancer, Faculty of Medicine, Imperial College London, St Mary's Hospital, 10 ^th Floor QEQM Building, South Wharf Road, London W2 1NY, UK. E-mail: e.zacharakis@ 123456imperial.ac.uk

Article

Publisher ID: JMAS-7-201

DOI: 10.4103/0972-9941.85642

PMC ID: 3193689

PubMed ID: 22022108

SO-VID: 2eba2fcc-bdb0-4910-b964-233daa17002e

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Obturator hernias: A review of the laparoscopic approach

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Abstract

BACKGROUND:

MATERIALS AND METHODS:

RESULTS:

CONCLUSION:

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Most cited references 25

Obturator hernia: diagnosis and treatment in the modern era.

Thirty-six cases of obturator hernia: does computed tomography contribute to postoperative outcome?

A review of obturator hernia and a proposed algorithm for its diagnosis and treatment.

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