Bowel Diameter at the Obturator Canal as a Predictor of Bowel Resection in Incarcerated Obturator Hernias.

Abstract

<h4>Background</h4>Obturator hernias are a relatively rare condition that predominantly occurs in thin elderly women and are frequently associated with bowel incarceration. Therefore, early diagnosis and appropriate treatment are vital. This study aimed to identify risk factors for bowel resection in patients with incarcerated obturator hernias and evaluate the clinical benefits of laparoscopic transabdominal preperitoneal repair (TAPP).<h4>Methods</h4>This retrospective study included 32 female patients diagnosed with incarcerated obturator hernias at our institution between January 2008 and June 2025. The patients were classified into bowel resection (<i>n</i> = 8) and non-resection (<i>n</i> = 24) groups. The clinical and radiological characteristics were compared. Furthermore, surgical outcomes were compared between the laparotomy (<i>n</i> = 18) and TAPP groups (<i>n</i> = 11).<h4>Results</h4>The median age was 86 years and the median body mass index (BMI) was 17.1. The bowel resection group had a significantly longer symptom duration (<i>P</i> < 0.001), a higher incidence of ileus on computed tomography (<i>P</i> = 0.041), and a significantly smaller bowel diameter at the obturator canal (<i>P</i> = 0.031). Cutoff values predictive of resection were identified as 36 h and 10.0 mm for the duration of symptoms and bowel diameter at the obturator canal, respectively. Multivariate analysis demonstrated that both factors were independent predictors of bowel resection (<i>P</i> = 0.045 and 0.040, respectively). Compared to laparotomy, TAPP resulted in significantly lower blood loss (<i>P</i> < 0.001) and shorter postoperative hospital stay (<i>P</i> < 0.001). In the TAPP group, contralateral obturator hernias were identified and simultaneously repaired in six patients (54.5%).<h4>Conclusion</h4>Symptom duration and bowel diameter at the obturator canal may serve as useful predictive factors for bowel resection in patients with incarcerated obturator hernias. TAPP is a minimally invasive and effective surgical strategy with favorable postoperative outcomes and the added advantage of bilateral hernia management.