Modified prolene* hernia system repair using preperitoneal approach for obturator hernia

Abstract

We evaluate modified Prolene* hernia system (PHS) repair using a preperitoneal approach for obturator hernia. We review the cases of 8 patients with obturator hernia (6 incarcerations and 2 nonincarcerations) treated between July 2000 and July 2001. All were diagnosed by pelvic computed tomography (CT). A4 cm transverse skin incision was made at a point estimated to be above the internal ring and continued to the obturator foramen using a preperitoneal approach. The hernia sac and contents incarcerated in the obturator canal were reduced by dilation of the obturator membrane using finger dissection. The obturator canal was closed suture-free with insertion of PHS whose onlay patch had been trimmed into the preperitoneal space. Where time lapsed over 4 days after symptom onset, we directly observed incarcerated intestines using laparoscopy. Mean time from symptom onset to surgery was 3.7 days in 6 incarcerated patients with the small intestine intact. Mean operation time was 50 min. Ingestion was started within postoperative day 2. Hospitalization averaged 5.2 days. No complication or recurrence occurred during the 13 months of follow-up after surgery. For nonincarcerated and early incarcerated obturator hernias, modified PHS repair using a preperitoneal approach is minimally invasive and enables complete closure of obturator canal.