Laparoscopic repair of sciatic hernia recognizing the ureterohypogastric nerve fascia and vesicohypogastric fascia: a case report

Background Sciatic hernias are rare pelvic floor hernias that occur through the sciatic foramen and often present as abdominal or pelvic pain, particularly in women. Historically, they were repaired using an open approach, with limited reports on their laparoscopic treatment. Case presentation Here we present the case of an 85-year-old woman who had repeated abdominal pain and was referred to our hospital for sciatic hernia surgery after conservative treatment. We laparoscopically observed the deep pelvis and identified the right sciatic hernia. When an extraperitoneal space was dissected, an ureterohypogastric nerve fascia (UNF) and a vesicohypogastric fascia (VF) were identified. Moreover, the maneuver to mobilize the fasciae inside from the pelvic wall made it possible to separate the ureter and urinary bladder, which might have otherwise incarcerated in the hernia. We repaired the defect of the sciatic foramen with a mesh plug and patch. The patient had an uneventful recovery, and the absence of sciatic herniation recurrence was confirmed 1 year after surgery. Conclusion A laparoscopic repair of a sciatic hernia could permit detailed non-invasive observations of the deep pelvis and be performed effectively by recognizing an UNF and a VF located near the sciatic foramen.

1669 Ureterosciatic Hernia: A Case Report and Review of the Literature

Aim Ureterosciatic hernia (USH) is an extremely unusual condition, with presentations ranging from asymptomatic, to flank pain, renal failure, septic shock and even obstructive uropathy. Due to its rarity, there are no recommendations on the treatment of USH. We therefore carried out a systemic review of published literature on its management. Method The systemic review was completed using three search terms: “uretero sciatic hernia”, “ureterosciatic hernia” and “ureteric sciatic hernia” on Healthcare Databases Advanced Search, producing 224 potential papers. This was narrowed down to 42 papers after using the PRISMA guidelines. All selected papers included a case report of USH, as well as the investigation and management in English only. Result We report a case of an 85-year-old female who was investigated for weight lost with Computed Tomography(CT), which showed an incidental finding of USH. She was managed conservatively after she denied any symptoms and had no hydronephrosis. Abdominal pain was the most common presentation of USH(64%), whilst only 9.5% were found incidentally. 79% of all patients had a CT scan which showed the pathognomonic “curlicue” sign. 55% of all patients had hydronephrosis. Half of all patients had surgical intervention, from open repair to laparoscopic to robotic(9.5% of all management)with no known mortality. Conservatively management(16.6%) was reserved for asymptomatic/poor surgical candidates, and were more likely to be followed up compared to surgical patients(55.5%vs47.6%). Conclusions Our case is of an incidental USH managed conservatively, with a literature review emphasising similarities to our case and the different management options.

Sciatic hernia: repair after recurrence

Sciatic hernia is a rare pelvic floor hernia. A variety of treatment modalities were proposed, but a guideline is lacking although a mesh-based tension-free repair may be preferred. A 67-year-old woman with an uncomplicated sciatic hernia received primarily closing of the hernia orifice that was covered with a preperitoneal mesh in March 2019. Six months later, she developed a clinical and radiographical recurrence requiring remedial surgery. Due to the previous mesh fixation, the preperitoneal plane was obliterated. Therefore, the pouch of Douglas was closed, leaving the hernia sac in place, by folding two opposing peritoneal layers and covering it with a Ventralight ST mesh. After 9 months, the hernia had not recurred and the patient was symptom-free. It is concluded that recurrent sciatic hernia may be treated by obliterating the Douglas pouch and subsequent mesh coverage.