Indications for treatment of incidental obturator hernia encountered during transabdominal preperitoneal repair (TAPP).

PURPOSE

To clarify indications for treating incidental obturator hernia (IOH) detected during laparoscopic groin hernia repair by comparing features of IOH with obturator hernia (OH) complicated by incarceration.

METHODS

Twenty patients who underwent laparoscopic OH repair between January 2017 and July 2024 were included in this retrospective study. They were divided into groups with incarceration or a past history of incarceration (the OH group) or without incarceration (the IOH group). Univariate analysis was performed, and ROC curves were constructed with the cut-off values representing indications for treating IOH.

RESULTS

Thirteen patients comprised the IOH group (bilateral in one), while seven comprised the OH group (all unilateral). Univariate analysis selected high age, low body mass index (BMI), and a large orifice as risk factors for incarceration. Cut-off values of these variables were age 89 years (area under curve, 0.816), BMI 17.7 kg/m (0.939), and orifice diameter 12 mm (0.796). Age of at least 89 years and BMI of 18 or less were more common in the incarceration group (P = 0.004, P = 0.007), and all patients in the incarceration group had orifices at least 12 mm in diameter. Assigning the 3 variables 1 point each, the OH group had significantly higher scores of at least 2 points (P < 0.001).

CONCLUSION

High age, low BMI, and large orifice diameter may be considered useful indicators for treating IOH. Two or more of these factors could place a patient at high risk for incarceration and show need for treatment of IOH.