Laparoscopic Mesh Repair of a Strangulated Right Obturator Hernia With Intraoperative Indocyanine Green Assessment of Bowel Viability: A Case Report.

Abstract

Obturator hernia is a rare condition. Due to its deep pelvic location, surgical management is often challenging. We present the case of an elderly woman admitted with abdominal pain, vomiting, and no passage of stool or flatus for five days. Computed tomography revealed a right obturator hernia with an incarcerated ileal loop. A laparoscopic transabdominal preperitoneal (TAPP) repair was performed. After peritoneal incision and dissection of the Retzius and Bogros spaces, the incarcerated bowel loop was reduced. A self-gripping polyester mesh was placed to cover the myopectineal orifice and obturator foramen, and the peritoneal flap was closed with an absorbable barbed suture. Intestinal perfusion was assessed intraoperatively using indocyanine green (ICG) fluorescence, which demonstrated a 3 cm infarcted segment requiring resection and hand-sewn, two-layer isoperistaltic anastomosis through a mini-umbilical incision. The postoperative course was uneventful with discharge on day five. This case highlights the feasibility and safety of the laparoscopic approach for strangulated obturator hernia, even in frail patients, and underscores the usefulness of ICG fluorescence in assessing bowel viability and avoiding unnecessary resections.