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Laparoscopic reduction and repair for incarcerated obturator hernia: comparison with open surgery



Transabdominal preperitoneal (TAPP) repair for obturator hernia (OH) is not well established. Therefore, we evaluated the efficacy of TAPP for OH repair compared with open surgery.


We retrospectively analyzed patients who underwent surgery for OH at our hospital between 2006 and 2011. Since 2009, we have used TAPP repair for OH instead of open surgery. The clinical results of TAPP repair were compared with those of open surgery performed before 2008.


Six patients with OH were treated by TAPP repair; occult contralateral OH was found by laparoscopic exploration in three (50 %) patients and was simultaneously repaired. Bowel incarceration was reduced by water pressure through Nelaton catheter in all but one patient. Bowel resection was performed in two patients after the laparoscopic assessment. For incarcerated OH, five of six cases were repaired using synthetic mesh, and the remaining case was addressed with simple peritoneal closure. Before 2008, six patients with OH underwent open surgery. The background of patients was comparable in the TAPP group and the open surgery group. There were no deaths in either group, but one metachronous contralateral OH occurred in the open surgery group within a short time frame, whereas none occurred in the TAPP group.


TAPP repair, including the inspection of the viability of the incarcerated intestine and protective reduction and assessment of the entire groin area is an effective and minimally invasive strategy for OH patients.

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  1. Maharaj D, Maharaj S, Young L, Ramdass MJ, Naraynsingh V (2002) Obturator hernia repair—a new technique. Hernia 6(1):45–47

    CAS  Article  PubMed  Google Scholar 

  2. Bjork KJ, Mucha P Jr, Cahill DR (1988) Obturator hernia. Surg Gynecol Obstet 167(3):217–222

    CAS  PubMed  Google Scholar 

  3. Bergstein JM, Condon RE (1996) Obturator hernia: current diagnosis and treatment. Surgery 119(2):133–136

    CAS  Article  PubMed  Google Scholar 

  4. Ng DCK, Tung KLM, Tang CN, Li MKW (2014) Fifteen-year experience in managing obturator hernia: from open to laparoscopic approach. Hernia 18:381–386

    CAS  Article  PubMed  Google Scholar 

  5. Lo CY, Lorentz TG, Lau PW (1994) Obturator hernia presenting as small bowel obstruction. Am J Surg 167(4):396–398

    CAS  Article  PubMed  Google Scholar 

  6. Cubillo E (1983) Obturator hernia diagnosed by computed tomography. Am J Roentgenol 140(4):735–736

    CAS  Article  Google Scholar 

  7. Gray SW, Skandalakis JE, Soria RE, Rowe JS Jr (1974) Strangulated obturator hernia. Surgery 75(1):20–27

    CAS  PubMed  Google Scholar 

  8. Chan KV, Chan CKO, Yau KW, Cheung MT (2014) Surgical morbidity and mortality in obturator hernia: a 10-year retrospective risk factor evaluation. Hernia 18:387–392

    CAS  Article  PubMed  Google Scholar 

  9. Ijiri R, Kanamaru H, Yokoyama H, Shirakawa M, Hashimoto H, Yoshino G (1996) Obturator hernia: the usefulness of computed tomography in diagnosis. Surgery 119(2):137–140

    CAS  Article  PubMed  Google Scholar 

  10. Wauschkuhn CA, Schwarz J, Boekeler U, Bittner R (2013) Laparoscopic versus open inguinal hernia repair. Surg Clin North Am 93(5):1269–1279

    Article  Google Scholar 

  11. Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350(18):1819–1827

    CAS  Article  PubMed  Google Scholar 

  12. Tucker JG, Wilson RA, Ramshaw BJ, Mason EM, Duncan TD, Lucas GW (1995) Laparoscopic herniorrhaphy: technical concerns in prevention of complications and early recurrence. Am Surg 61(1):36–39

    CAS  PubMed  Google Scholar 

  13. Haith LR Jr, Simeone MR, Reilly KJ, Patton ML, Moss BE, Shotwell BA (1998) Obturator hernia: laparoscopic diagnosis and repair. JSLS 2(2):191–193

    PubMed Central  PubMed  Google Scholar 

  14. Abrahamson J (1997) Hernia. In: Zinner MJ, Schwartz SI, Ellis H (eds) Maingot’s abdominal operation, 10th edn. Stamford, Appleton & Lange, pp 479–580

    Google Scholar 

  15. Yokoyama T, Kobayashi A, Kikuchi T, Hayashi K, Miyagawa S (2011) Transabdominal preperitoneal repair for obturator hernia. World J Surg 35(10):2323–2327

    Article  PubMed  Google Scholar 

  16. Sze Li S, Kenneth Kher Ti V (2012) Two different surgical approaches for strangulated obturator hernias. Malays J Med Sci 19(1):69–72

    PubMed Central  PubMed  Google Scholar 

  17. Fujita J, Uyama I, Sugioka A, Komori Y, Matsui H, Soga R (2000) Experience with laparoscopic repair of a strangulated obturator hernia: report of a case. Dig Endosc 12:338–340

    Article  Google Scholar 

  18. Shapiro K, Patel S, Choy C, Chaudry G, Khalil S, Ferzli G (2004) Totally extraperitoneal repair of obturator hernia. Surg Endosc 18(6):954–956

    CAS  Article  PubMed  Google Scholar 

  19. Martínez Insua C, Costa Pereira JM, Cardoso de Oliveira M (2001) Obturator hernia: the plug technique. Hernia 5(3):161–163

    Article  PubMed  Google Scholar 

  20. Tchupetlowsky S, Losanoff J, Kjossev K (1995) Bilateral obturator hernia: a new technique and a new prosthetic material for repair–case report and review of the literature. Surgery 117(1):109–112

    CAS  Article  PubMed  Google Scholar 

  21. Miki Y, Sumimura J, Hasegawa T, Mizutani S, Yoshioka Y, Sasaki T, Kamike W, Ito T, Monta O, Nagai I (1998) A new technique of laparoscopic obturator hernia repair: report of a case. Surg Today 28(6):652–656

    CAS  Article  PubMed  Google Scholar 

  22. Yau KK, Siu WT, Chau CH, Yang PC, Li MK (2005) Laparoscopic management of incarcerated obturator hernia. Can J Surg 48(1):76–77

    PubMed Central  PubMed  Google Scholar 

  23. Sinha SN, DeCosta AE (1983) Obturator hernia. Aust N Z J Surg 53(4):349–351

    CAS  Article  PubMed  Google Scholar 

  24. Mantoo SK, Mak K, Tan TJ (2009) Obturator hernia: diagnosis and treatment in the modern era. Singap Med J 50(9):866–870

    CAS  Google Scholar 

  25. Karasaki T, Nomura Y, Tanaka N (2014) Long-term outcomes after obturator hernia repair: retrospective analysis of 80 operations at a single institution. Hernia 18:393–397

    CAS  Article  PubMed  Google Scholar 

  26. Sawayama H, Kanemitsu K, Okuma T, Inoue K, Yamamoto K, Baba H (2014) Safety of polypropylene mesh for incarcerated groin and obturator hernias: a retrospective study of 110 patients. Hernia 18:399–406

    CAS  Article  PubMed  Google Scholar 

  27. Deeba S, Purkayastha S, Darzi A, Zacharakis E (2011) Obturator hernias: a review of the laparoscopic approach. J Minim Access Surg 7(4):201–204

    PubMed Central  Article  PubMed  Google Scholar 

  28. Felix EL, Michas CA, Gonzalez MH Jr (1995) Laparoscopic hernioplasty. TAPP vs. TEP. Surg Endosc 9(9):984–989

    CAS  PubMed  Google Scholar 

  29. Togawa Y, Muronoi T, Kawaguchi H, Chiku T, Sano W, Hashiba T, Ueda A, Kaneoya K (2014) Minimal incision transinguinal repair for incarcerated obturator hernia. Hernia 18:407–411

    CAS  Article  PubMed  Google Scholar 

  30. Humes DJ, Radcliffe RS, Camm C, West J (2013) Population-based study of presentation and adverse outcomes after femoral hernia surgery. Br J Surg 100(13):1827–1832

    CAS  Article  PubMed  Google Scholar 

  31. Karasaki T, Nakagawa T, Tanaka N (2014) Obturator hernia: the relationship between anatomical classification and the Howship–Romberg sign. Hernia 18:413–416

    CAS  Article  PubMed  Google Scholar 

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Conflict of interest

S. H., K. O., Y. T., T. I., N. S. and S. H. declare no conflicts of interest.

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Correspondence to S. Hayama.

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Hayama, S., Ohtaka, K., Takahashi, Y. et al. Laparoscopic reduction and repair for incarcerated obturator hernia: comparison with open surgery. Hernia 19, 809–814 (2015).

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  • Transabdominal preperitoneal repair
  • Obturator hernia
  • Protective reduction