Does Laparoscopy Increase the Detection of Obturator Hernias During Inguinal Hernia Repair?

Stanton T Smith, MD, Cayton Frenzel, MD, Arun Mavanur, MD, Bruce Bernstein, PhD, Kristine O’Hara, MD, Ibrahim M Daoud, MD. Division of Minimally Invasive Surgery, Department of Surgery and Minimally Invasive Surgery Fellowship Program, Saint Francis Hospital and Medical Center, Hartford, CT, USA.

INTRODUCTION- The reported incidence of obturator hernias (OH) is 0.07-0.1% of all inguinal hernias. With increasing laparoscopic approaches to inguinal hernia repair more occult OHs are visualized and easily repaired (thereby increasing the incidence of OH). Because of the higher mortality from bowel obstruction associated with OH and the difficulty in diagnosing OH, we sought to review one surgeon’s experience with occult OH and his approach to laparoscopic repair.

METHODS AND PROCEDURES- A retrospective chart review of patients undergoing laparoscopic repair of inguinal hernias from November1992-September 2010 was performed looking for patients with occult or primary OH. Data collected included patient demographics, symptoms, and details of surgery. Whether totally extraperitoneal (TEP), or transabdominal preperitoneal (TAPP) procedures.

RESULTS- 3269 charts were reviewed and 13 patients were identified (0.4%). 12 (92%) were female. Mean age was 62 years (range 15-93). 3 had groin pain, 7 had recurrent inguinal hernias, 2 had femoral hernias, and one had an incarcerated femoral hernia. Only one patient had bilateral OHs. All were repaired via a laparoscopic technique with mesh 12 TEP, 1 TAPP. All, but one went home same day. The one patient with an incarcerated femoral hernia went home post op day one.

CONCLUSION(S)- We present one of the largest reported series of obturator hernias. In our experience, OH is more common than reported in the literature (0.4%). The number of patients with OH will likely increase in the future aging population. A laparoscopic approach allows easier intra-operative recognition of these hernias and is the most probable explanation for the higher incidence in our study. It is most important to keep the possibility of OH in mind when performing laparoscopic inguinal hernia repair, especially elderly women. OH may be successfully repaired with either laparoscopic approach.