Evaluation of Four-Hand Reduction for Obturator Hernia with The Guidance of Sonography (FROGS) as a New Treatment Strategy for Obturator Hernia: A Retrospective Study

Background Obturator hernias are uncommon but are important causes of intestinal obstruction. Delayed treatment can be fatal. Emergency surgery is considered the most effective treatment; however, patients with obturator hernia usually have comorbidities, and this precludes them from emergency surgery. Previously, a few case studies reported successful manual reductions for an incarcerated obturator hernia. However, their efficacy was not statistically confirmed. We have devised a new manual reduction method for an incarcerated obturator hernia based on previous studies. We have named this method “Four-hand Reduction for Obturator hernia with the Guidance of Sonography” (FROGS). This study aimed to evaluate the effectiveness of FROGS as a new treatment strategy for obturator hernia. Methods Since November 2019, we have tried FROGS in all patients with obturator hernia at the emergency room. We retrospectively compared the clinical data of 14 patients who underwent FROGS (after-FROGS group) with those of 23 patients who did not (before-FROGS group). Results All patients were females. There were no significant differences in age, lesion side, duration of symptoms, the diameter of the prolapsed bowel, and predisposing factors. The body mass index was significantly lower in the after-FROGS group than in the before-FROGS group. Manual reduction was successfully performed in all 14 patients in the FROGS group, whereas in the before-FROGS group, 14 patients underwent manual reduction, of whom only one was successfully treated using the non-FROGS method. Bowel resection was avoided in all 14 patients in the after-FROGS group, whereas 8 patients underwent bowel resection in the before-FROGS group. There were no significant differences in postoperative complications and mortality within 30 days after hernia presentation between the two groups. Conclusion Manual reduction using the FROGS technique was found to be safe and reproducible and can be the first treatment choice for patients with obturator hernia.

Effective Treatment for Incarcerated Obturator Hernia With Bowel Dilatation by Combined Laparoscopy and Preperitoneal Approach: A Case Report

Background: We report a case of a 90-year-old woman with intestinal obstruction due to left-sided incarcerated obturator hernia, which was revealed using computed tomography. Methods: Emergency surgerywas performed using laparoscopy, which showed a dilated small intestine and bilateral obturator hernia in the intraperitoneal space. After reducing incarceration of the small intestine using laparoscopy, we approached the bilateral preperitoneal space and inserted a Kugel patch via a small lower abdominal median incision (approximately 4 cm). Results: The patient was discharged on postoperative day 10 and showed no recurrence at the 18-month follow-up. Although relatively rare, obturator hernia can significantly cause intestinal obstruction. It has no specific clinical symptoms and is thus often difficult to diagnose. Treating obturator hernia is essential; however, mesh infection, recurrence, and opposite side of the obturator hernia should be carefully monitored. Conclusions: Although laparoscopy is used for treating obturator hernia, it may be difficult in patients with intestinal obstruction. In this case, a surgical technique combining laparoscopy and preperitoneal space approach via a small lower abdominal median incision was used to effectively treat an incarcerated occult bilateral obturator hernia.