Two cases of incarcerated obturator hernia repaired by laparoscopic-assisted intraperitoneal with totally extraperitoneal approach

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 73; no. 6; pp. 1587 - 1591
• Main Authors: TAKAYAMA, Hiroto, MATSUSHITA, Keiji, SHIMADA, Ryou, UCHIKAWA, Yuji
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2012
• Subjects: incarceration; laparoscopic surgery; obturator hernia
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.73.1587

Case 1 involved a 97-year-old woman complaining of abdominal pain and vomiting. She was diagnosed as having a right incarcerated obturator hernia by abdominal CT scan and underwent emergency operation. Laparoscopic observation revealed the right obturator hernia with an incarcerated small bowel within the hernia sac and a femoral hernia as well. After the incarcerated small bowel was reduced, the hernia was repaired by laparoscopic totally extraperitoneal (TEP) approach. Observation under re-pneumoperitoneum showed no necrosis in the incarcerated bowel and the surgical wound was closed. Case 2 involved a 93-year-old woman complaining of abdominal pain and vomiting. She was diagnosed as having a right incarcerated obturator hernia and was emergently operated on. Laparoscopic observation revealed an incarcerated small bowel within the right obturator hernia, as well as bilateral femoral hernias and a left obturator hernia. After the incarcerated small bowel was reduced, the bilateral hernias were repaired by TEP approach. Observation under re-pneumoperitoneum disclosed a necrotic portion in the incarcerated small bowel. Extracorporeal resection of the necrotic portion was performed, followed by anastomosis and closure. This paper deals with successful TEP associated with intraperitoneal approach for incarcerated obturator hernia in two cases, together with a review of the literature.