title: Endoscopic totally extraperitoneal repair for occult bilateral obturator hernias and multiple groin hernias.
abstract: BACKGROUND
  An obturator hernia is a rare hernia that is bilateral in about 6% of patients. Most patients present with chronic pelvic pain although a few patients may present with features of intestinal obstruction. Only about 10% of obturator hernias are diagnosed preoperatively.
  
  
  METHODS
  A 65-year-old female patient with chronic obstructive pulmonary disease presented with bilateral groin swellings associated with local pain and heaviness. She also suffered from recurrent episodes of abdominal distension. She was diagnosed to have bilateral direct inguinal hernias and a left femoral hernia. At endoscopy under epidural anesthesia she was found to have a direct inguinal, an indirect inguinal, and a femoral hernia on the left side and an indirect inguinal hernia on the right side. Additionally, the endoscopic totally extraperitoneal approach to inguinal hernias identified hitherto undiagnosed bilateral obturator hernias. The hernias were reduced and polypropylene mesh was placed bilaterally covering the myopectineal orifice and pelvic floor bilaterally.
  
  
  RESULTS
  The patient was discharged the next day and is symptom-free on followup at eight months.
  
  
  CONCLUSIONS
  Endoscopic repair of groin hernias allows the surgeon not only to diagnose and treat unsuspected groin hernias but also allows identification, dissection, and repair of coincidental occult pelvic hernias like obturator hernias at the same time.
authors.affiliation: Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India. chowbey@del2.vsnl.net.in
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Chowbey
authors.forename: Samik Kumar
authors.initials: SK
authors.lastname: Bandyopadhyay
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khullar
authors.forename: Vandana
authors.initials: V
authors.lastname: Soni
authors.forename: Manish
authors.initials: M
authors.lastname: Baijal
authors.forename: Atul
authors.initials: A
authors.lastname: Wadhwa
authors.forename: Anil
authors.initials: A
authors.lastname: Sharma
mesh_terms: D000368:Aged; D005260:Female; D006552:Hernia, Inguinal / Q000150:complications / Q000601:surgery*; D006553:Hernia, Obturator / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D013526:Surgical Mesh