Schizas D, Apostolou K, Hasemaki N, Kanavidis P, Tsapralis D, Garmpis N, Damaskos C, Alexandrou A, Filippou D, Kontzoglou K
First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 Str., Goudi, 11527, Athens, Greece.
Surgical Department, General Hospital of Ierapetra, Ierapetra, Greece.
Hernia. 2021 Feb;25(1):193-204. doi: 10.1007/s10029-020-02282-8. Epub 2020 Aug 9.
Obturator hernias (OH) are extremely rare hernias, accounting for 0.07-1% of all hernias. This is the first systematic review investigating their presentation, imaging, treatment outcomes, and recurrence rate.
After a detailed search in electronic search engines, 74 studies matched our criteria. A review of these reports was conducted and the full texts were examined.
A total of 146 patients with a mean age of 78.8 years were included in our analysis, with 40.1%, 29.9%, and 25.2% of patients suffering from either a right, a left or bilateral OH, respectively. OH were associated with non-specific symptoms and signs; bowel obstruction being the most common. Howship-Romberg sign was present in 56.2% of patients. Computed tomography (CT) scan was the most frequently used diagnostic modality, inversely associated with perioperative mortality. Mesh repair demonstrated a significantly improved perioperative morbidity rate, compared with non-mesh repair. Approximately 30% of patients underwent a laparoscopic operation, which was associated with significantly decreased morbidity and mortality rate as well as length of hospital stay, compared with the open repair.
OHs are not associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair.
闭孔疝极为罕见，占所有疝的0.07 - 1%。这是第一项系统评价闭孔疝的临床表现、影像学表现、治疗结果及复发率的研究。
在电子搜索引擎中进行详细检索后，有74项研究符合我们的标准。对这些报告进行了综述并查阅了全文。
我们的分析纳入了146例患者，平均年龄78.8岁，其中分别有40.1%、29.9%和25.2%的患者患有右侧、左侧或双侧闭孔疝。闭孔疝与非特异性症状和体征相关；肠梗阻最为常见。56.2%的患者出现Howship-Romberg征。计算机断层扫描（CT）是最常用的诊断方法，与围手术期死亡率呈负相关。与非补片修补相比，补片修补的围手术期发病率显著改善。约30%的患者接受了腹腔镜手术，与开放修补相比，腹腔镜手术的发病率、死亡率以及住院时间均显著降低。
闭孔疝与特异性症状和体征无关；因此，其诊断具有挑战性，需要高度的临床怀疑。毫无疑问，腹部CT扫描是金标准诊断工具。必须对其进行手术修补，腹腔镜手术方式相较于开放手术具有显著优势。
