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Management and outcomes of obturator hernias: a systematic review and meta-analysis

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Abstract

Purpose

Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair.

Methods

PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4.

Results

One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11–0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25–1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28–1.25; p = 0.17; I2 = 50%) between both groups.

Conclusion

Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient’s clinical status, comorbidities, and degree of intraoperative contamination.

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Data availability

Because this meta-analysis was based on data extracted from previously published research, all the data and study materials are available in the public domain. The authors of this meta-analysis do not have access to patient-level data of the individual studies. Researchers with an interest in individual-level data from the studies included in this meta-analysis are encouraged to contact the corresponding author from each study for such request.

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Acknowledgements

The authors would like to thank Rhanderson Cardoso M.D. for supporting this research.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Medicine, Estacio de Sa Vista Carioca University, RJ, Rio de Janeiro, Brazil

    M. M. Burla

  2. Department of Obstetrics and Gynecology, Maimonides Medical Center, New York, NY, USA

    C. P. Gomes

  3. Department of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, KGD, Russian Federation

    I. Calvi

  4. Department of Medicine, University of Brasilia, Brasilia, DF, Brazil

    E. S. C. Oliveira

  5. Department of Medicine, Federal University of Amazonas, Manaus, AM, Brazil

    D. A. B. Hora

  6. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA

    R. D. Mao, S. M. P. de Figueiredo & R. Lu

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Contributions

All authors contributed to the study's conception and design. MMB, CPG, and IC performed material preparation, data collection, and analysis. The first draft of the manuscript was written by MMB, CPG, IC, SMPF, and R-MDM. All authors critically reviewed previous versions of the manuscript. All authors read and approved the final manuscript. All authors agree to be accountable for all aspects of the work.

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Correspondence to M. M. Burla.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. Dr. Sergio Mazzola Poli de Figueiredo and Dr. Rui-Min Diana Mao have no disclosures. Dr. Richard Lu received payment/honoraria for lectures and presentations from Intuitive Surgical that are unrelated to this work.

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Burla, M.M., Gomes, C.P., Calvi, I. et al. Management and outcomes of obturator hernias: a systematic review and meta-analysis. Hernia 27, 795–806 (2023). https://doi.org/10.1007/s10029-023-02808-w

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