Diagnosis and laparoscopic repair of type I obturator hernia in women with chronic neuralgic pain

Abstract

Background: We performed a pilot study review of 7 female patients suffering with obturator neuralgia produced by a type I obturator hernia. Diagnosis and laparoscopic treatment of this rare hernia are presented.

Methods: Patients with chronic pelvic pain and signs of obturator neuralgia were identified retrospectively by chart review. These patients had been referred to our chronic pelvic pain clinic. Outcomes of their surgery from February through November 2001 were analyzed. Median length of follow-up was 11 months (range, 6 to 16). A new technique using Cooper's ligament and arcus tendineus fasciae pelvis was used for the tension-free mesh hernia repair.

Results: In this pilot study, 6 of 7 patients (86%) received greater than 50% relief of their chronic pelvic pain, which leads to the conclusion that we have at least 95% confidence that the pain reduction achieved is greater that 50%. Due to the small sample size, no statistically meaningful conclusions could be reached. All of the patients have reported some pain relief and increased function since surgery.

Conclusion: Symptomatic type I obturator hernias may be more common than previously thought. Patients with obturator neuralgia, persisting longer than 6 months despite conservative therapy, may respond to laparoscopic reduction of the pilot fat tag and mesh overlay of the obturator canal.

Figure 1.

Vaginal compression of either or both divisions of the obturator nerve by the hernia may reproduce pain (HowshipRomberg sign). Used with permission: Pelvic Pain: Diagnosis and Management. Howard F, Perry CP, Carter JE, El-Minawi AM, eds. Philadelphia, PA: Lippincott Williams & Wilkins, 2000:391.

Figure 2.

Removal of the compressing pilot tag from the obturator canal.

Figure 3.

Polypropylene mesh secured to Cooper's ligament and tendineus fascia pelvis.