Elective plug repair of an incarcerated obturator hernia by the thigh approach after noninvasive manual reduction: report of two cases.

An obturator hernia is a rare type of pelvic hernia, which can cause bowel obstruction. Despite improved imaging techniques, which can allow us to make a preoperative diagnosis, emergency laparotomy is still often carried out. We repaired this hernia electively in two elderly women by inserting a plug into the obturator canal via the thigh, after noninvasive manual reduction. Both patients were brought to our Emergency Department after the sudden onset of severe pain in the thigh or groin. The diagnosis was confirmed by computed tomography, and manual reduction was performed immediately thereafter. Since both patients had undergone groin hernia surgery of the identical side before, less-invasive inguinal or extraperitoneal approaches were considered impossible, but laparotomy seemed too invasive. Despite being an unfamiliar field for general surgeons, the thigh approach gives excellent and easy access to the obturator canal. The technique we describe is especially useful for patients who have undergone previous groin hernia operations. We expect that this method will become a standard technique for obturator hernias without strangulation.