Obturator Hernia Diagnosis and Surgical Management

Obturator hernia is a rare pelvic protrusion of abdominal contents through the obturator canal, predominantly affecting elderly, emaciated women. Clinical presentation often includes non-specific signs of intestinal obstruction such as abdominal pain, nausea and medial thigh pain due to compression of the obturator nerve. Delayed recognition can lead to strangulation and high mortality. Modern diagnosis has been transformed by cross-sectional imaging, particularly computed tomography (CT), which reliably identifies the hernial sac and its contents. Management strategies range from emergency open laparotomy to elective minimally invasive procedures. Elective repair following successful non-invasive reduction may reduce postoperative complications. Surgical options include open and laparoscopic techniques, with mesh reinforcement through extraperitoneal or intraperitoneal approaches. Recent innovations focus on hybrid procedures that combine laparoscopy with limited access for bowel resection and the adoption of self-gripping or biosynthetic meshes to accommodate patient frailty. Perioperative mortality remains low when diagnosis is timely and an appropriate surgical plan is established, underscoring the importance of heightened clinical suspicion and multidisciplinary management.

Research from Nature Portfolio

Recent studies have assessed the safety and efficacy of manual reduction for incarcerated obturator hernias as a bridge to elective surgery. A retrospective review of fifty cases over twelve years showed that manual reduction succeeded in approximately 40 per cent of patients. Those with successful reduction underwent elective extraperitoneal mesh repair and experienced no mortality, whereas emergent surgery in irreducible cases was associated with higher complication rates. These findings demonstrate that a non-invasive initial approach, coupled with careful monitoring for late-onset constriction or perforation, can be a viable strategy to optimise surgical outcomes for high-risk patients.

Obturator Hernia Diagnosis and Surgical Management publication trend

The graph below shows the total number of articles in obturator hernia diagnosis and surgical management across all publications each year (not limited to Nature Index journals).

Technical terms

Obturator hernia: Protrusion of abdominal contents through the obturator canal, often presenting with bowel obstruction and thigh pain.

Incarceration: Trapping of hernial contents that cannot be reduced, risking vascular compromise.

Strangulation: Impaired blood supply to the herniated tissue, leading to ischaemia and potential perforation.

Manual reduction: Non-invasive repositioning of hernial contents into the abdominal cavity through external manipulation.

Extraperitoneal mesh repair: Surgical placement of a prosthetic mesh outside the peritoneal cavity to reinforce the hernia defect.

Laparoscopic repair: Minimally invasive approach using small abdominal incisions and a camera to guide hernia repair.

Echo-guided reduction: Use of ultrasound imaging to assist in non-invasive reduction of herniated tissue.

References

1. Manual reduction for incarcerated obturator hernia. Scientific Reports (2023).
2. Diagnosis and treatment of obturator hernia: retrospective analysis of 86 clinical cases at a single institution. BMC Surgery (2021).
3. Laparoscopic assisted repair of strangulated obturator hernia—Way to go. International Journal of Surgery Case Reports (2019).
4. Ultrasound-guided non-invasive retraction for strangulated obturator hernia allows elective radical surgery: analysis of 12 cases. Surgical Case Reports (2021).
5. Case report: Laparoscopic totally extraperitoneal repair of an obturator hernia with self-gripping mesh under spinal anaesthesia. International Journal of Surgery Case Reports (2019).