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      Diagnosis and Laparoscopic Repair of Type I Obturator Hernia in Women With Chronic Neuralgic Pain

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          Abstract

          Background:

          We performed a pilot study review of 7 female patients suffering with obturator neuralgia produced by a type I obturator hernia. Diagnosis and laparoscopic treatment of this rare hernia are presented.

          Methods:

          Patients with chronic pelvic pain and signs of obturator neuralgia were identified retrospectively by chart review. These patients had been referred to our chronic pelvic pain clinic. Outcomes of their surgery from February through November 2001 were analyzed. Median length of follow-up was 11 months (range, 6 to 16). A new technique using Cooper's ligament and arcus tendineus fasciae pelvis was used for the tension-free mesh hernia repair.

          Results:

          In this pilot study, 6 of 7 patients (86%) received greater than 50% relief of their chronic pelvic pain, which leads to the conclusion that we have at least 95% confidence that the pain reduction achieved is greater that 50%. Due to the small sample size, no statistically meaningful conclusions could be reached. All of the patients have reported some pain relief and increased function since surgery.

          Conclusion:

          Symptomatic type I obturator hernias may be more common than previously thought. Patients with obturator neuralgia, persisting longer than 6 months despite conservative therapy, may respond to laparoscopic reduction of the pilot fat tag and mesh overlay of the obturator canal.

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          Most cited references 7

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          Diagnosis and treatment of obturator hernia.

          Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n = 7) or an inguinal approach (n = 5). The hernial orifice was closed using the uterine fundus (n = 6), a patch (n = 5), and direct suture (n = 1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery.
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            Obturator hernia.

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              Some Clinical Aspects of Peripheral Nerve Lesions

               M Mumenthaler (1969)
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                Author and article information

                Contributors
                Brookwood Women's Hospital, Birmingham, Alabama and Consulting Staff Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
                University of North Texas Heath Science Center-Texas College of Osteopathic Medicine, Fort Worth, Texas, USA.
                Journal
                JSLS
                JSLS
                jsls
                jsls
                JSLS
                JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Society of Laparoendoscopic Surgeons (Miami, FL )
                1086-8089
                1938-3797
                Apr-Jun 2005
                : 9
                : 2
                : 138-141
                Affiliations
                Brookwood Women's Hospital, Birmingham, Alabama and Consulting Staff Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
                University of North Texas Heath Science Center-Texas College of Osteopathic Medicine, Fort Worth, Texas, USA.
                Author notes
                Address reprint requests to: C. Paul Perry, MD, Pelvic Pain Center, Brookwood Women's Medical Center, 2006 Brookwood Medical Center Drive, Suite 402, Women's Medical Plaza, Birmingham, AL 35209, USA. Telephone: 205 877 2950, Fax: 205 877 2973, E-mail: cpperry@ 123456aol.com
                3015584
                15984699
                © 2005 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                Product
                Categories
                Scientific Papers

                Surgery

                obturator hernia, obturator neuralgia, laparoscopic hernia repair

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