Koichi Takiguchi, Shunji Kinuta, Kazuma Sato, Naoyuki Hanari, Naoki Koshiishi. Takeda General Hospital
Introduction: It is difficult to diagnose obturator hernias by routine physical examination.Obturator hernias are frequently complicated by ileus and the diagnosis is often first made from abdominal CT. Obturator hernias are difficult to reduce, and often necessitate emergency surgery. They are common in elderly people, and they often had bad general condition. So it was high in the death rate. At our hospital, we first attempt to reduce the hernia from the body surface under ultrasonographic guidance. After relieving the strangulation, we perform radical operation electively in patients who are for possible for surgery under the general anesthesia. We perform laparoscopic repair for obturator hernias. Obturator hernias are often complicated by other types of hernia. In these cases, we perform total repair. Herein, we present a review of the patients who underwent surgery for obturator hernia at our hospital.
Methods: We review the data of 9 cases of obturator hernia encountered by us from February 2012 to December 2014.We performed total repair in three of the cases. However, it is difficult to procure a mesh that would be adequate for all the defects (inner inguinal ring, femoral ring, obturator). No single mesh can fit, because the inguinal and pelvic curves present opposing curves near the obturator. Therefore, we placed two pieces of mesh available at our hospital (3D max [Bard] and onlay sheet of Kugel patch[Bard]) together in the patientsWe could successfully cover all the defects using these two pieces of mesh and could fit the mesh to the pelvic shape by devising an appropriate connection between the meshes.
Results: We reviewed a total of 9 operated cases for obturator hernia. The hernia was bilateral in 7 cases, and complicated by other hernias in 6 cases. We first determined the appropriate approach for the repair.We performed total repair in 3 cases.They were no complications and no cases of recurrence.
Conclusion: Our approach to the repair of obturator hernias was very useful. We can use the exact area and shape of the mesh needed in individual patients by this method. We show the method of shaping the mesh to fit the pelvic form.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86572
Program Number: P067
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster