Therapeutic Strategy for Incarcerated Obturator Hernia Using Preoperative Manual Reduction and Laparoscopic Repair

Hirofumi Kawanaka, Shoji Hiroshige, Nobuhide Kubo, Teijiro Hirashita, Takeshi Masuda, Yushi Kaisyakuji, Hirotada Tajiri, Akinori Egashira, Toshifumi Matsumoto, Tokujiro Yano

Research output: Contribution to journalArticle

Abstract

Background: Obturator hernia (OH) is a rare but serious disease associated with high morbidity and mortality due to advanced patient age and comorbidities. This study evaluated the feasibility of a laparoscopic approach to OH. Study Design: We retrospectively reviewed the records of 32 patients (median age 84 years; 31 women) with OH treated between 2003 and 2016. Results: Five patients with incidental OH underwent total extraperitoneal (TEP) repair. Of 27 patients with incarcerated OH, 18 patients underwent laparotomy, 13 of which required bowel resection, and the remaining 9 patients underwent preoperative ultrasound-guided manual OH reduction. Of 6 patients with successful OH release, 3 and 2 patients underwent TEP and transabdominal preperitoneal repair, respectively, and 1 patient declined the operation. Three patients with failure underwent laparoscopic exploration and conversion to open operation for bowel resection. Comparing the open and laparoscopic groups, the median operation times were 67.5 minutes vs 124 minutes, respectively (p = 0.004); median postoperative stay was 19 vs 11 days, respectively (p = 0.028); and Clavien-Dindo grade II or higher complications tended to be lower (28% vs 8%, respectively; p = 0.359). Even in patients without bowel resection, the median postoperative stay was significantly shorter in the laparoscopic group compared with the open group (7.5 vs 15 days, respectively; p = 0.032). During a mean follow-up of 24.5 months, the 3-year recurrence rate for OH was 25% for non-mesh repair and 0% for mesh repair (p = 0.335). Three- and 5-year cumulative survival rates were 83% and 71%, respectively. Conclusions: Laparoscopic operations after ultrasound-guided manual reduction can be an alternative to emergent laparotomy in select OH patients.

Original languageEnglish
Pages (from-to)891-901
Number of pages11
JournalJournal of the American College of Surgeons
Volume226
Issue number5
DOIs
Publication statusPublished - May 1 2018

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Obturator Hernia
Therapeutics
Laparotomy
Feasibility Studies
Rare Diseases

All Science Journal Classification (ASJC) codes

  • Surgery

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Therapeutic Strategy for Incarcerated Obturator Hernia Using Preoperative Manual Reduction and Laparoscopic Repair. / Kawanaka, Hirofumi; Hiroshige, Shoji; Kubo, Nobuhide; Hirashita, Teijiro; Masuda, Takeshi; Kaisyakuji, Yushi; Tajiri, Hirotada; Egashira, Akinori; Matsumoto, Toshifumi; Yano, Tokujiro.

In: Journal of the American College of Surgeons, Vol. 226, No. 5, 01.05.2018, p. 891-901.

Research output: Contribution to journalArticle

Kawanaka, H, Hiroshige, S, Kubo, N, Hirashita, T, Masuda, T, Kaisyakuji, Y, Tajiri, H, Egashira, A, Matsumoto, T & Yano, T 2018, 'Therapeutic Strategy for Incarcerated Obturator Hernia Using Preoperative Manual Reduction and Laparoscopic Repair', Journal of the American College of Surgeons, vol. 226, no. 5, pp. 891-901. https://doi.org/10.1016/j.jamcollsurg.2018.02.009
Kawanaka, Hirofumi ; Hiroshige, Shoji ; Kubo, Nobuhide ; Hirashita, Teijiro ; Masuda, Takeshi ; Kaisyakuji, Yushi ; Tajiri, Hirotada ; Egashira, Akinori ; Matsumoto, Toshifumi ; Yano, Tokujiro. / Therapeutic Strategy for Incarcerated Obturator Hernia Using Preoperative Manual Reduction and Laparoscopic Repair. In: Journal of the American College of Surgeons. 2018 ; Vol. 226, No. 5. pp. 891-901.
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AU - Kawanaka, Hirofumi

AU - Hiroshige, Shoji

AU - Kubo, Nobuhide

AU - Hirashita, Teijiro

AU - Masuda, Takeshi

AU - Kaisyakuji, Yushi

AU - Tajiri, Hirotada

AU - Egashira, Akinori

AU - Matsumoto, Toshifumi

AU - Yano, Tokujiro

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Y1 - 2018/5/1

N2 - Background: Obturator hernia (OH) is a rare but serious disease associated with high morbidity and mortality due to advanced patient age and comorbidities. This study evaluated the feasibility of a laparoscopic approach to OH. Study Design: We retrospectively reviewed the records of 32 patients (median age 84 years; 31 women) with OH treated between 2003 and 2016. Results: Five patients with incidental OH underwent total extraperitoneal (TEP) repair. Of 27 patients with incarcerated OH, 18 patients underwent laparotomy, 13 of which required bowel resection, and the remaining 9 patients underwent preoperative ultrasound-guided manual OH reduction. Of 6 patients with successful OH release, 3 and 2 patients underwent TEP and transabdominal preperitoneal repair, respectively, and 1 patient declined the operation. Three patients with failure underwent laparoscopic exploration and conversion to open operation for bowel resection. Comparing the open and laparoscopic groups, the median operation times were 67.5 minutes vs 124 minutes, respectively (p = 0.004); median postoperative stay was 19 vs 11 days, respectively (p = 0.028); and Clavien-Dindo grade II or higher complications tended to be lower (28% vs 8%, respectively; p = 0.359). Even in patients without bowel resection, the median postoperative stay was significantly shorter in the laparoscopic group compared with the open group (7.5 vs 15 days, respectively; p = 0.032). During a mean follow-up of 24.5 months, the 3-year recurrence rate for OH was 25% for non-mesh repair and 0% for mesh repair (p = 0.335). Three- and 5-year cumulative survival rates were 83% and 71%, respectively. Conclusions: Laparoscopic operations after ultrasound-guided manual reduction can be an alternative to emergent laparotomy in select OH patients.

AB - Background: Obturator hernia (OH) is a rare but serious disease associated with high morbidity and mortality due to advanced patient age and comorbidities. This study evaluated the feasibility of a laparoscopic approach to OH. Study Design: We retrospectively reviewed the records of 32 patients (median age 84 years; 31 women) with OH treated between 2003 and 2016. Results: Five patients with incidental OH underwent total extraperitoneal (TEP) repair. Of 27 patients with incarcerated OH, 18 patients underwent laparotomy, 13 of which required bowel resection, and the remaining 9 patients underwent preoperative ultrasound-guided manual OH reduction. Of 6 patients with successful OH release, 3 and 2 patients underwent TEP and transabdominal preperitoneal repair, respectively, and 1 patient declined the operation. Three patients with failure underwent laparoscopic exploration and conversion to open operation for bowel resection. Comparing the open and laparoscopic groups, the median operation times were 67.5 minutes vs 124 minutes, respectively (p = 0.004); median postoperative stay was 19 vs 11 days, respectively (p = 0.028); and Clavien-Dindo grade II or higher complications tended to be lower (28% vs 8%, respectively; p = 0.359). Even in patients without bowel resection, the median postoperative stay was significantly shorter in the laparoscopic group compared with the open group (7.5 vs 15 days, respectively; p = 0.032). During a mean follow-up of 24.5 months, the 3-year recurrence rate for OH was 25% for non-mesh repair and 0% for mesh repair (p = 0.335). Three- and 5-year cumulative survival rates were 83% and 71%, respectively. Conclusions: Laparoscopic operations after ultrasound-guided manual reduction can be an alternative to emergent laparotomy in select OH patients.

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