A case report and a contemporary review of incarcerated and strangulated obturator hernia repair

BACKGROUND: Obturator hernia (OH) usually presents as a surgical emergency, with open primary repair most commonly performed. Given the morbidity and high recurrence of this approach, we present a case and review the literature to evaluate the influence of the operative approach on OH repair. METHODS: A literature search via PubMed was performed. Inclusion criteria were studies that: (1) were written in English and published within 10 years; (2) included as keywords “obturator hernia” and/or “incarcerated” and/or “strangulated”; (3) reported the operative approach; and (4) reported postoperative outcomes. RESULTS: Overall, 225 studies were identified, and 53 met the inclusion criteria. Data from 425 patients were pooled. Open repair without mesh was performed in 239 (56.2%) patients, 121 (28.5%) had open repair with mesh, 44 (10.4%) had laparoscopic repair with mesh, and 21 (4.9%) had laparoscopic repair without mesh. Open repair had a mean hospital length of stay (LOS) of 13.4 days, 40.3% postoperative complications, and 9.7% 30-day mortality rate whereas laparoscopic repair had a mean LOS of 7.9 days, 3.1% postoperative complications, and no deaths. Small bowel resection (SBR) was performed in 44.7% of open and 15.4% of laparoscopic repairs. Patients with SBR demonstrated higher morbidity and mortality compared with patients without SBR. In patients without SBR, laparoscopy had advantages over open surgery in LOS, complications, and mortality rate. The overall recurrence rate was 7.7%, with a mean follow-up of 20.4 months. One (0.7%) recurrence was reported in mesh repair, whereas 28 (12.1%) recurrences were reported with tissue repair. CONCLUSION: OHs are the most common open repair without mesh. Our literature review showed that laparoscopic OH repair is associated with enhanced postoperative recovery and the use of mesh was associated with less recurrence. Further studies are still necessary to determine the optimal approach for OH repair, but laparoscopic repair with mesh should be performed when possible.