Elective surgery of totally extraperitoneal approach after manual reduction of incarcerated obturator hernia Reina MIYAMOTO 1 , Makoto MIZUTANI 1 , Isao SATO 1 , Iwao KITAZONO 1 , Tomotake TABATA 1 , Masaki FUJIMURA 1 1Laparoscopic Surgery Center of Daiichi Towakai Hospital Keyword: 閉鎖孔ヘルニア嵌頓 , 超音波下用手的整復 , 腹腔鏡下ヘルニア手術 pp.257-262
Published Date 2014/5/15
DOI https://doi.org/10.11477/mf.4426101090
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An 87-year-old woman was admitted to the hospital because of appetite loss and nausea. Abdominal X-ray and computed tomography(CT) revealed bowel obstruction caused by a left incarcerated obturator hernia. After she was referred to our hospital, hernia content was successfully reduced manually with the guidance of ultrasound. To prevent another incarceration, elective laparoscopy surgery of hernia repair with totally extraperitoneal approach(TEP) was performed. Observation of abdominal cavity using endoscopic laparoscopy identified bilateral obturator hernia. The hernias were reduced and polypropylene mesh was placed bilaterally covering the entire space to fully cover indirect, direct, femoral, and obturator hernias. In our institution, modified TEP procedure which combines conventional TEP with the observation of abdominal cavity is used, enabling us to detect other asymptomatic obturator hernia and allowing us to confirm the position of the mesh. Incarcerated obturator hernia frequently occurrs in elderly women with high incidence of emergency operation. Moreover, emergency hernia repair of elderly people can lead to high mortality rate, and it is difficult to perform implantation of the mesh in such situation. Elective laparoscopic surgery after manual reduction of hernia content is desirable when possible.

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