Diagnosis and laparoscopic repair of type I obturator hernia in women with chronic neuralgic pain.
BACKGROUND
We performed a pilot study review of 7 female patients suffering with obturator neuralgia produced by a type I obturator hernia. Diagnosis and laparoscopic treatment of this rare hernia are presented.


METHODS
Patients with chronic pelvic pain and signs of obturator neuralgia were identified retrospectively by chart review. These patients had been referred to our chronic pelvic pain clinic. Outcomes of their surgery from February through November 2001 were analyzed. Median length of follow-up was 11 months (range, 6 to 16). A new technique using Cooper's ligament and arcus tendineus fasciae pelvis was used for the tension-free mesh hernia repair.


RESULTS
In this pilot study, 6 of 7 patients (86%) received greater than 50% relief of their chronic pelvic pain, which leads to the conclusion that we have at least 95% confidence that the pain reduction achieved is greater that 50%. Due to the small sample size, no statistically meaningful conclusions could be reached. All of the patients have reported some pain relief and increased function since surgery.


CONCLUSIONS
Symptomatic type I obturator hernias may be more common than previously thought. Patients with obturator neuralgia, persisting longer than 6 months despite conservative therapy, may respond to laparoscopic reduction of the pilot fat tag and mesh overlay of the obturator canal.
Pelvic Pain Center, Brookwood Women's Medical Center, 2006 Brookwood Medical Center Drive, Suite 402, Women's Medical Plaza, Birmingham, AL 35209, USA. cpperry@aol.com
C Paul
CP
Perry
Jeffrey M
JM
Hantes
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006553:Hernia, Obturator / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology* / Q000601:surgery; D009776:Obturator Nerve; D017699:Pelvic Pain / Q000209:etiology / Q000601:surgery; D010865:Pilot Projects; D012189:Retrospective Studies; D016896:Treatment Outcome