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.

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.

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.