Analysis of clinical characteristics and management of obturator hernia: a report of 10 cases
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1.Department of Gastrointestinal, Hernia and Abdominal Wall Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, China;2.Department of Hernia and Abdominal Wall Surgery, Huadong Hospital, Fudan University, Shanghai 200040, China

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R656.2

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    Abstract:

    Background and Aims Obturator hernia is a relatively rare type of external abdominal hernia, and elderly women are more susceptible to this condition due to characteristics such as pelvic floor laxity. The narrow and non-elastic nature of the obturator ring often leads to patients seeking medical treatment due to acute abdomen caused by bowel incarceration, typically discovered during surgery for intestinal obstruction. Completely suturing the semi-rigid hernia ring can be challenging, which leads to a higher risk of hernia recurrence and a high reoperation rate, but the use of repair materials can effectively reduce this risk. In this article, the authors analyze the disease characteristics and share clinical experiences in the diagnosis and treatment of obturator hernia through review treated cases of obturator hernia, in the hope of providing reference for the clinical diagnosis and treatment of this condition.Methods The clinical data of 10 patients with obturator hernia treated in the Department of Hernia and Abdominal Wall Surgery, Huadong Hospital Affiliated to Fudan University and Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2019 to June 2021 were retrospectively summarized.Results All ten patients were females, aged between 48 and 86 years, with a median age of (70.7±11.8) years. Prior to surgery, all patients underwent abdominal and pelvic CT scans, which identified left-sided obturator hernia in 2 cases and right-sided obturator hernia in 8 cases. The contents of incarcerated hernia identified by intraoperative findings were intestinal canal in 8 cases, greater omentum in 1 case, and extraperitoneal fat in 1 case. There were no absolute contraindications to tension-free repair in the entire group. Based on the degree of abdominal contamination, 2 patients received biological mesh, while the remaining 8 patients received polypropylene mesh. Six cases were completely repaired laparoscopically, one case required conversion to an open surgery after laparoscopic repair due to poor recovery of intestinal vitality, and one case underwent laparotomy for intestinal resection and hernia repair after initial laparoscopic exploration. Two patients directly underwent open laparotomy for repair due to poor tolerance of laparoscopic operation. The surgery duration ranged from 50 to 120 min, with an average of 75.5 min. One patient died from concomitant medical condition during perioperative period, while the rest were discharged uneventfully with hospital stay lasting 3 to 28 d. Follow-up at 6, 12, and 18 months after operation showed no recurrences or mesh-related infections.Conclusion Obturator hernia has a low incidence and often presents with concealed symptoms, making incarceration common. Abdominal and pelvic CT scans are valuable for diagnosis. Using mesh repair with appropriate fixation can help reduce the recurrence rate. In cases of abdominal contamination, one-stage synthetic mesh repair is feasible, with biological mesh having an advantage in cases of severe contamination. If the repair site is severely infected, mesh repair should be avoided.

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XING Jingxiao, GAO Lei, GU Yan, LI Shaochun, TANG Jianxiong. Analysis of clinical characteristics and management of obturator hernia: a report of 10 cases[J]. Chin J Gen Surg,2023,32(10):1508-1515.
DOI:10.7659/j. issn.1005-6947.2023.10.009

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History
  • Received:February 16,2023
  • Revised:April 17,2023
  • Adopted:
  • Online: November 02,2023
  • Published: