Laparoscopic Repair of Ureteral Obturator Hernia Using Extended TAPP Technique: A Case Report.

Abstract

BACKGROUND Obturator hernias are very rare and mostly affect elderly women. Among these, obturator hernia with ureteral entrapment is exceptionally rare. Diagnosis and surgical treatment can be very difficult and is usually performed by an open surgical technique. Here we present the first published case of a ureteral obturator hernia where a laparoscopic extended transabdominal preperitoneal patch technique (TAPP) was performed for hernia repair. CASE REPORT In this case, a 79-year-old woman was referred to the emergency department because of right-sided flank pain that had been present for weeks with pain exacerbation since the previous evening. Imaging of the urinary tract showed distal herniation of the ureter into the right obturator canal. Laparoscopic hernioplasty with mobilization of the bladder, release of the right ureter from the obturator hernia, and simultaneous treatment of an additionally incidentally discovered femoral hernia by mesh implantation using an extended TAPP technique was performed. In addition to the primary hernia repair, careful dissection and protection of the ureter during surgery ensured optimal preservation of its function. This approach ensured protection of the ureter from further adhesions, with precise mesh positioning and fixation, preventing any damage to surrounding structures, including the intestine. The patient was discharged on the third day after surgery without any wound infections, dysesthesia, or bladder dysfunction. CONCLUSIONS By presenting this case report we hope to increase the awareness of rare hernias such as obturator hernias. Physicians should make accurate diagnosis based on physical examination, laboratory investigations, and imaging. The patient's uneventful recovery and lack of postoperative complications underscore the benefits of laparoscopic approaches even in rare cases, offering reduced morbidity and quicker recovery compared to traditional open surgery.