Epidemiology and surgical management of 184 obturator hernias: a nationwide registry-based cohort study.

PURPOSE: We aimed describe the patient characteristics, surgical details, postoperative outcomes, and prevalence and incidence of obturator hernias. Obturator hernias are rare with high mortality and no consensus on the best surgical approach. Given their rarity, substantial data is lacking, especially related to postoperative outcomes. METHODS: The study was based on data from the nationwide Danish Hernia Database. All adults who underwent obturator hernia surgery in Denmark during 1998-2023 were included. The primary outcomes were demographic characteristics, surgical details, postoperative outcomes, and the prevalence and incidence of obturator hernias. RESULTS: We included 184 obturator hernias in 167 patients (88% females) with a median age of 77 years. Emergency surgeries constituted 42% of repairs, and 72% were laparoscopic. Mesh was used in 77% of the repairs, with sutures exclusively used in emergency repairs. Concurrent groin hernias were found in 57% of cases. Emergency surgeries had a 30-day mortality of 14%, readmission rate of 21%, and median length of stay of 6 days. Elective surgeries had a 30-day mortality of 0%, readmission rate of 10%, and median length of stay of 0 days. The prevalence of obturator hernias in hernia surgery was 0.084% (95% CI: 0.071%-0.098%), with an incidence of one per 400,000 inhabitants annually. CONCLUSIONS: This was the largest cohort study to date on obturator hernias. They were rare, affected primarily elderly women. The method of repair depends on whether the presentation is acute, and emergency repair is associated with higher mortality.

A decade review of emergency obturator hernia repairs.

BACKGROUND: Obturator hernia is a rare pelvic hernia associated with a high morbidity and mortality. It most commonly occurs in elderly, multiparous females with symptoms and signs of small bowel obstruction. We present an Australian hospital network experience on emergency presentations of obturator hernias highlighting differences between clinical profile and surgical management. METHODS: A retrospective review of adult patients diagnosed with acute obturator hernia during a 10 year period (2010-2020) was conducted across 10 major Sydney hospitals in New South Wales, Australia. RESULTS: Obturator hernia was diagnosed in 18 patients (mean 82.7 years, range: 60-96 years old), all confirmed on pre-operative computed tomography imaging. The most common presentations were elderly women demonstrating clinical features of a small bowel obstruction. The mean onset of symptoms from home to hospital admission was 49.4 h. Non-survivors had a significantly elevated urea level (15.6 vs. 7.8 mmol/L, p = 0.036) at presentation and a longer delay from onset of presenting symptoms to diagnosis (84.0 vs. 36.2 h, p = 0.028). Eleven patients underwent urgent laparotomy and six laparoscopic repairs. The mean operative time was 101.0 min. The average hospital length of stay was 16.2 days with a mortality rate of 27.8%. CONCLUSION: Timely diagnosis and operative intervention for obturator hernia is the cornerstone of management.

Sciatic hernia: is it really rare?

PURPOSE: It is generally believed that sciatic hernia is extremely rare; however, asymptomatic sciatic hernia is occasionally found in patients with an obturator hernia. We investigated the frequency, risk factors, and prognosis of asymptomatic sciatic hernia, which have never been discussed in a published report. METHODS: We retrospectively reviewed multidetector-row computed tomography (MDCT) images of 38 consecutive cases of new-onset obturator hernia. The co-existence of sciatic hernia was diagnosed from the MDCT findings of some of these patients. The clinical characteristics and clinical courses were compared between the sciatic hernia group and the non-sciatic hernia group. RESULTS: Nine patients (24 %) had concomitant asymptomatic sciatic hernias, five (13 %) of which were bilateral.The body mass index (BMI) was significantly lower in the patients with a concomitant sciatic hernia (17.2 ± 2.4 kg/m(2)) than in those without a sciatic hernia (19.6 ± 2.6 kg/m(2); P = 0.02). All patients received treatment for incarcerated obturator hernias, but none underwent repair of the concomitant sciatic hernia because all were non-incarcerated and asymptomatic. None of the patients has had trouble with their untreated sciatic hernia after the obturator hernia treatment. CONCLUSIONS: Up to 24 % of these obturator hernia patients had a concomitant sciatic hernia. A low BMI was a risk factor for concomitant sciatic hernia. Immediate surgical repair of the sciatic hernia may not be needed, unless it is symptomatic.

Surgical morbidity and mortality in obturator hernia: a 10-year retrospective risk factor evaluation.

UNLABELLED: Obturator hernia is a rare condition occurring predominantly in elderly, thin, female patients and causes significant morbidity and mortality. Due to obscure presenting symptoms and signs, diagnosis and management are often delayed. While previous studies have attributed the high mortality to the delay in diagnosis, current literature remains controversial about this issue. The aim of this study was to identify peri-operative risk factors associated with mortality in patients with obturator hernia at our hospital. METHODS: We retrospectively reviewed our series of 20 consecutive patients who underwent surgical repair of 21 obturator herniae and examined their clinical characteristics and post-operative outcomes. RESULTS: Overall mortality rate was 47.6 %. Survivors did not differ from non-survivors in terms of basic demographics and operative parameters (operative time, blood loss and the need for intestinal resection). The use of computed tomography for pre-operative diagnosis was associated with reduced need for bowel resection, but did not result in shorter time to operation or improved morbidity and mortality. Our series demonstrated that early timing of surgery alone did not improve operative outcome. The absence of bowel motion and a high serum urea level at the time of operation were independent factors for mortality. CONCLUSIONS: Obturator hernia remains a highly lethal surgical emergency. Adequate peri-operative resuscitation may be the key to further improvement in surgical outcomes.

Obturator hernia--a condition seldom thought of and hence seldom sought.

PURPOSE: Obturator hernia is an extremely rare type of hernia with an incidence of less than 1% of all abdominal wall hernias occurring predominantly in elderly females characterized by protrusion of the intra-abdominal viscera into the obturator foramen. It presents with pain along the medial aspect of the thigh referred to the knee due to compressed obturator nerve and sometimes as an uncommon cause of intestinal obstruction. It remains a clinical diagnostic dilemma and often perplexing the decision for surgery. This explanatory review emphasizes and illuminates its various facets under the rationale of its diagnosis and management to familiarize surgeons with the condition. METHODS: The data for the present review was obtained by searching in PubMed and other databases using key terms "obturator hernia", "abdominal hernia", "intestinal obstruction", and "Howship-Romberg sign". Many original articles, reviews, and case reports were selected. RESULTS: Since it is very rare that a mass can be found on inspection of the medial aspect of the thigh and the clinical signs are not always present, hence obturator hernia is a condition which leads to both difficult and delayed clinical diagnosis and consequently having a significant morbidity and mortality rates, especially in the elderly. CONCLUSION: Obturator hernia should always be in the differential diagnosis in septuagenarian to nonagenarian patients with nonspecific signs and symptoms of intestinal obstruction. Computed tomography of abdomen and pelvis has been found to be the gold standard for preoperative diagnosis and this condition necessitates immediate surgical reduction and repair of the defect either by open or laparoscopic approach.

Obturator hernia in an ageing society.

INTRODUCTION: Obturator hernia is an important cause of small bowel obstruction and is associated with difficult diagnosis and high mortality. MATERIALS AND METHODS: We reviewed 22 cases of intestinal obstruction due to obturator hernia that necessitated surgical intervention over the last 17 years and evaluated the changes in the number of patients based on the census data. RESULTS: All cases were elderly females. The Howship-Romberg sign was present in 15 patients (68%). Computed tomography (CT) correctly diagnosed 13/15 (87%) of cases in which it was performed prospectively. The median time to surgery was 7.5+/-5.2 days for those patients with bowel resection, compared to 0.8+/-1.3 days for those without (P <0.05). The number of patients with obturator hernia has increased with an ageing society. CONCLUSIONS: The rising incidence of obturator hernia is probably linked to an ageing society. CT of the pelvis was helpful in obtaining the correct diagnosis. The shorter the delay between admission and surgery, the lower the bowel resection rate. Laparotomy at an early stage is recommended in such patients as it leads to reduced morbidity and mortality.

Sixty-one cases of obturator hernia in Chiangrai Regional Hospital: retrospective study.

OBJECTIVE: To review the patient characteristics and clinical symptoms, intraoperative finding and management, including morbidity and mortality rate of obturator hernia cases. MATERIAL AND METHOD: A retrospective study was performed in 61 patients diagnosed as obturator hernia at Chiangrai Regional Hospital between January 2000 and December 2005. RESULTS: The incidence of obturator hernia is 61 of 2,828 cases (2.2%) of all hernias, female:male 6.6:1. The mean age was 72.85 years. The mean body weight was 35.72 Kg. Howship-Romberg's sign were positive in eight patients (13.11%). Thirty-five patients (57.38%) were Richter type hernia, left:right side 3:2. Strangulation of bowel occurred in 41 patients (67.21%) Mortality rate was 11.47%. All patients with postoperative complications and all deaths showed bowel strangulation and all were more than 70 years of age. CONCLUSION: In the present study, the authors found a high incidence of obturator hernia (2.2% of all hernias) compared with a previous report (0.05%-1.4% of all hernias). This high incident rate might relate to the specific local life style of people in Chiangrai as most patients had a habit of smoking. Chronic obstructive pulmonary disease (COPD), old age, and low body weight were possible contributing factors. Bowel strangulation and age more than 70 years old were associated with morbidity and mortality.

Hernia obturatriz: análisis de nuestra serie y revisión de la enfermedad / Obturator hernia: analysis of our series and review of the entity

Introducción. La hernia obturatriz es una rara entidad, con frecuente ausencia de signos y síntomas específicos que retrasa su diagnóstico y tratamiento 1,4; por ello, presenta una elevada tasa de estrangulación herniaria. Objetivo. Presentamos nuestra experiencia en el manejo de esta enfermedad. Pacientes y métodos. Revisamos 12 casos de hernia obturatriz, en 11 pacientes intervenidos entre el año 1986 y 2001. Se analizan los siguientes parámetros: epidemiología, clínica, métodos diagnósticos, tratamiento y evolución. Resultados. Todos los pacientes eran mujeres con una edad media de 73 años (rango, 19-88). Una de ellas había presentado una recidiva herniaria a los 13 años de la reparación inicial. La manifestación clínica más frecuente fue, la de dolor y distensión abdominal, vómitos y estreñimiento. La exploración física y la radiología simple eran compatibles con una obstrucción intestinal en 11 casos (91,6 por ciento). Sólo en 2 pacientes la exploración rectal reveló la presencia de una tumoración en el orificio obturador; se les practicó una ecografía abdominopélvica que fue diagnóstica en el 50 por ciento de los casos. El diagnóstico preoperatorio fue de obstrucción intestinal de origen desconocido en 8 casos (66,6 por ciento), obstrucción intestinal por hernia obturatriz complicada en 2 ocasiones (16,6 por ciento), obstrucción intestinal por hernia inguinal incarcerada en un paciente (8,3 por ciento) y hernia inguinal recidivada en otro caso (8,3 por ciento). Se realizaron 11 intervenciones con carácter urgente (91,6 por ciento) y una de forma electiva (8,3 por ciento). La tasa de estrangulación herniaria fue del 50 por ciento. En todos los casos el contenido herniario fue del intestino delgado. Se observó un ligero predominio de herniaciones en el lado derecho (8 casos; 66,6 por ciento). En 4 ocasiones se reparó el defecto heniario con una malla de polipropileno (33,3 por ciento), siendo con cierre simple y aposición del peritoneo en los restantes 8 casos. Un total de 7 pacientes precisó resección intestinal (58,3 por ciento). Nuestro índice de mortalidad se situó en el 16,6 por ciento (2 pacientes), la demora media en el diagnóstico fue de 3,6 días (rango, 0-10) y la estancia media hospitalaria de, 14,5 días (rango, 6-26). Conclusión. Son esenciales el diagnóstico y tratamiento precoz en el manejo de esta enfermedad1,5. (AU)

Obturator hernia: a new technique for repair.

An obturator hernia is exceedingly rare and the diagnosis is usually made at laparotomy for small bowel obstruction. Several methods of dealing with the hernial defect have been described. Two cases of obturator hernias in nonagenarians are reported and a new, simple and effective method of repairing the hernia by suturing a polypropylene (Prolene) mesh to Cooper's ligament is proposed.

Laparoscopic herniorrhaphy: technical concerns in prevention of complications and early recurrence.

Laparoscopic herniorrhaphy continues to gain popularity, but should be subjected to proper scrutiny before widespread acceptance. From 5/91 to 6/93, 290 transabdominal preperitoneal (TAPP) laparoscopic herniorrhaphies were performed on 244 adult patients at Georgia Baptist Medical Center. Procedures consisted of indirect (164), direct (73), femoral (5), obturator (7), and recurrent (41) hernia repairs, with a mean operative time of 81.2 minutes (range 30-193 min). The overall technical complication rate was 5.3% and includes lateral thigh paresthesias (6), inferior epigastric artery injury (4), enterotomy during adhesiolysis (1), bowel obstruction secondary to herniation through a lateral trocar site (1), and bladder injury (1). The recurrence rate is 1% (3/290), with a mean follow up of 11 months (range 2-27 months). The authors present herein a discussion of technical considerations in an attempt to help decrease complications and recurrence as others incorporate laparoscopic hernia repair into their surgical armamentarium.

Obturator hernia--case reports.

Two cases of obturator hernia are presented. Both patients presented with intestinal obstruction and the diagnosis was not made preoperatively. A review of recent articles showed 57 cases of obturator hernia in 53 patients reported in the period 1981 to 1990 which also showed no improvement in the management of these cases with a high mortality rate of 30%. A high index of suspicion must be maintained in order to diagnose this condition and reduce morbidity and mortality.

Obturator hernia presenting as small bowel obstruction.

Obturator hernia is a rare but important cause of small bowel obstruction that is associated with difficult diagnosis and high mortality. In the past 7 years, 16 patients with small bowel obstruction due to obturator hernia diagnosed at operation were seen at the Department of Surgery, the University of Hong Kong, Queen Mary Hospital. They represented 1% (16 of 1,554) of all hernia repair performed and 1.6% (16 of 1,000) of mechanical intestinal obstruction encountered during the same period. Elderly emaciated women with chronic disease were commonly affected. All patients presented with partial or complete mechanical small bowel obstruction. Right-sided obturator hernia outnumbered left-sided hernia, and bilateral hernia was found in only one patient. The majority of patients required resection of their strangulated small bowel. Most of the hernial orifices were closed with interrupted nonabsorbable sutures. Morbidity and mortality rates were significantly high for this group of debilitated patients with chronic disease who underwent late operation for this elusive diagnosis.

[The obturator hernia: a diagnostic challenge?]. / L'ernia otturatoria: una sfida diagnostica?

Obturator hernias are relatively rare. Elderly women with chronic diseases are most frequently affected. Mechanical small bowel obstruction is the most common presenting symptom. Cause the Howship-Romberg sign is found in only 20% of cases, a correct preoperative diagnosis is uncommon. Midline abdominal incision is thought to be the better approach, allowing an easy reduction of the incarcerated ileum and a direct repair of the defect. Contralateral side exploration is recommended, being bilateral hernias quite common. The prognosis, despite our own results, remains severe for the compromised general conditions of the great majority of the patients.