Therapeutic strategy for incarcerated obturator hernia: laparoscopic surgery after ultrasound-guided noninvasive manual reduction.

BACKGROUND

Obturator hernia is a rare but serious disease associated with high morbidity and mortality, as it usually develops in the elderly. Herein, we evaluated the results of a less-invasive strategy for incarcerated obturator hernia (IOH) treated by laparoscopic repair after ultrasound sonography reduction. Study design: We retrospectively reviewed the records of 15 consecutive patients with IOH treated between April 2019 and March 2025.

RESULTS

Fifteen patients with IOH were treated at our hospital. Of these, 13 patients underwent ultrasound-guided, non-invasive manual reduction. One patient underwent emergency laparotomy due to suspected small bowel necrosis, and one patient underwent emergency laparoscopic surgery due to unsuccessful reduction. Elective laparoscopic surgery was attempted in 12 patients, of whom 10 patients underwent laparoscopic mesh-plug hernioplasty. One patient developed bowel necrosis and perforation after manual reduction and subsequently underwent laparoscopic surgery with simple ligation. One patient required conversion to open surgery due to intraperitoneal adhesions. One patient died of age-related causes without undergoing surgery after manual reduction.

CONCLUSIONS

Laparoscopic repair after ultrasound-guided manual reduction for IOH is an effective and minimally invasive therapeutic strategy. However, patients with IOH are often elderly and frail, with multiple comorbidities; moreover, the small intestine may become incarcerated, leading to necrosis and perforation. Therefore, early diagnosis and intervention are essential. Additionally, continuous and careful evaluation of the patient's overall condition throughout treatment is necessary.