A new technique of laparoscopic obturator hernia repair: report of a case.
An 84-year-old woman presented with ileus. Ultrasonography, a computed tomography scan, and small bowel contrast examination showed a Richter-type hernia in her left obturator orifice. Under general anesthesia, laparoscopic surgery with low-pressure (4mmHg) pneumoperitoneum was carried out using a peritoneal needle retractor, and a reduction of the strangulated intestinal loop was thus achieved. Because the hernial opening measured 5mm in diameter, it could be closed with four pieces of End-Universal stapler without polypropylene mesh. The ischemic ileum was resected, and the bowel was anastomosed extracorporeally with a minimal skin incision. She was ambulant on the first postoperative day, and her postoperative course was good. Obturator hernias are rare, but when a definitive diagnosis is made in such elderly patients, laparoscopic repair using the peritoneal needle retractor is recommended for minimally invasive surgery. We recommend doing the repair with an End-Universal stapler, since this procedure is more simple and useful for preventing infection than using polypropylene mesh in such a strangulated case.
Department of Surgery, Kinan General Hospital, Tanabe, Wakayama, Japan.
Y
Y
Miki
J
J
Sumimura
T
T
Hasegawa
S
S
Mizutani
Y
Y
Yoshioka
T
T
Sasaki
W
W
Kamike
T
T
Ito
O
O
Monta
I
I
Nagai
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006553:Hernia, Obturator / Q000150:complications / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D017792:Surgical Stapling