Midline Extraperitoneal Approach for Obturator Hernia Repair

被引:8
作者
Otsuki, Yuji [1 ,2 ]
Konn, Hirofumi [2 ]
Takeda, Keisa [2 ]
Koike, Masahiko [2 ]
机构
[1] Keio Univ, IAMR, Div Gene Regulat, Sch Med, Tokyo, Japan
[2] KKR Sapporo Med Ctr, Dept Surg, Sapporo, Hokkaido, Japan
关键词
extraperitoneal approach; infection; mesh repair; obturator hernia; postoperative complication;
D O I
10.2302/kjm.2017-0014-OA
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Obturator hernia (OH) is a rare condition that accounts for 0.073-1% of abdominal hernias and 0.48% of bowel obstructions. OH frequently occurs in elderly women, with an incidence that increases with age. The only treatment for OH is surgical intervention, and the approaches used vary greatly. Consequently, a well-defined consensus has not yet emerged. We assessed the efficiency and safety of the midline extraperitoneal approach for OIL Six patients with OH repaired using the midline extraperitoneal approach at KKR Sapporo Medical Center between April 2011 and January 2016 were included in the study. We retrospectively evaluated the patient characteristics, intraoperative findings, and the postoperative course. All patients were elderly women [median age, 90 (range, 79-92) years], with a median body mass index of 17.0 (range, 15.6-18.3) kg/m(2) at presentation. All had symptoms associated with bowel obstruction: two patients presenting with leg pain had the Howship-Romberg sign. In two patients, bowel resection was required because of irreversible ischemic changes. Five patients had coexisting femoral and inguinal hernias that were repaired by bilateral mesh repair. One patient had aspiration pneumonia as a postoperative complication. All patients were discharged alive, without infection or recurrence. OH can be efficiently and safely repaired using the midline extraperitoneal approach. This approach establishes the diagnosis of OH, avoids injuring obturator vessels, gives improved exposure of the obturator canal, enables identification and simultaneous repair of other pelvic hernias, and facilitates bowel resection. This approach reduces the risk of mesh infection in patients undergoing bowel resection.
引用
收藏
页码:67 / 71
页数:5
相关论文
共 24 条
[1]   Obturator hernia: Current diagnosis and treatment [J].
Berstein, JM ;
Condon, RE .
SURGERY, 1996, 119 (02) :133-136
[2]  
BJORK KJ, 1988, SURG GYNECOL OBSTET, V167, P217
[3]  
Carter JE, 2002, NYHUS CONDONS HERNIA, P539
[4]   Endoscopic totally extraperitoneal repair for occult bilateral obturator hernias and multiple groin hernias [J].
Chowbey, PK ;
Bandyopadryay, SK ;
Khullar, R ;
Soni, V ;
Baijal, M ;
Wadhwa, A ;
Sharma, A .
JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES-PART A, 2004, 14 (05) :313-316
[5]  
Dundamadappa S K, 2006, Singapore Med J, V47, P89
[6]   Laparoscopic reduction and repair for incarcerated obturator hernia: comparison with open surgery [J].
Hayama, S. ;
Ohtaka, K. ;
Takahashi, Y. ;
Ichimura, T. ;
Senmaru, N. ;
Hirano, S. .
HERNIA, 2015, 19 (05) :809-814
[7]  
HSU CH, 1993, AM SURGEON, V59, P709
[8]   Forty-three cases of obturator hernia [J].
Kammori, M ;
Mafune, K ;
Hirashima, T ;
Kawahara, M ;
Hashimoto, M ;
Ogawa, T ;
Ohta, H ;
Hashimoto, H ;
Kaminishi, M .
AMERICAN JOURNAL OF SURGERY, 2004, 187 (04) :549-552
[9]   Long-term outcomes after obturator hernia repair: retrospective analysis of 80 operations at a single institution [J].
Karasaki, T. ;
Nomura, Y. ;
Tanaka, N. .
HERNIA, 2014, 18 (03) :393-397
[10]  
Kong T, 2002, NIHON RINSHO GEKA GA, V63, P1847, DOI [10.3919/jjsa.63.1847, DOI 10.3919/JJSA.63.1847]