From the Guidelines
The management of obturator hernia requires immediate surgical intervention to prevent complications such as bowel strangulation and perforation, which can significantly increase morbidity and mortality rates 1.
Key Considerations
- Initial management includes fluid resuscitation, correction of electrolyte imbalances, and nasogastric decompression for patients presenting with bowel obstruction.
- Antibiotics such as piperacillin-tazobactam or cefazolin plus metronidazole should be administered if bowel ischemia or perforation is suspected.
- The surgical approach may be either open or laparoscopic, with the abdominal approach preferred over the thigh approach due to better visualization and easier reduction of the hernia.
- During surgery, the hernia sac is reduced, non-viable bowel is resected with primary anastomosis, and the defect is closed using either simple sutures or mesh repair depending on the size of the defect and presence of contamination.
Postoperative Care
- Postoperatively, patients require pain management, early mobilization, and gradual advancement of diet.
- Obturator hernias require surgical management because they have a high risk of strangulation due to the rigid boundaries of the obturator canal, and the mortality rate can be significant (10-40%) if treatment is delayed, particularly in elderly, thin females who are the most commonly affected population 1.
Important Recommendations
- Patients should undergo emergency hernia repair immediately when intestinal strangulation is suspected (grade 1C recommendation) 1.
- Systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, serum creatinine phosphokinase (CPK), and D-dimer levels are predictive of bowel strangulation (grade 1C recommendation) 1.
- The use of mesh in clean surgical fields (CDC wound class I) is associated with a lower recurrence rate, if compared to tissue repair, without an increase in the wound infection rate (grade 1A recommendation) 1.
From the Research
Management of Obturator Hernia
The management of obturator hernia typically involves surgical intervention, as it is a rare and potentially life-threatening condition with high morbidity and mortality rates if left untreated 2, 3, 4, 5, 6.
- Surgical Approaches: Various surgical approaches have been described, including open repair, laparoscopic repair, and laparoscopic-assisted repair 2, 5, 6.
- Laparoscopic Repair: Laparoscopic repair is a minimally invasive technique that has been shown to be effective in managing obturator hernia, with the advantage of reducing morbidity and promoting faster recovery 2, 6.
- Mesh Repair: The use of synthetic mesh in the preperitoneal space has been recommended for the repair of obturator hernia, as it allows for a more durable repair and can be used in both unilateral and bilateral cases 3.
- Modified Mesh-Plug Hernioplasty: A modified mesh-plug hernioplasty has also been described as a successful technique for managing obturator hernia, particularly in cases with small bowel obstruction 4.
- Diagnostic Tools: Computed tomography (CT) scan is considered the gold standard for diagnosing obturator hernia, due to its high sensitivity and ability to accurately identify the hernia and any associated complications 3, 4, 5.
Key Considerations
- Early Diagnosis: Early diagnosis and treatment are crucial in reducing the morbidity and mortality associated with obturator hernia 2, 3, 4, 5, 6.
- Surgical Timing: The timing of surgical intervention is critical, with delays in treatment leading to increased morbidity and mortality 3, 6.
- Patient Awareness: Heightened awareness of the condition among healthcare providers and patients is essential for early detection and treatment 4, 6.