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. 2026 Jan 20;18(1):e101888.
doi: 10.7759/cureus.101888. eCollection 2026 Jan.

Obturator Hernia: A Critical Appraisal of Treatment Strategies Based on 10 Cases and Current Literature: Towards a Pragmatic Surgical Algorithm

Yujo Kawashita  1 , Eri Daicho  1 , Noriko Ikeda  1 , Masaki Tateishi  1 , Takashi Ueda  1
Affiliations

Obturator Hernia: A Critical Appraisal of Treatment Strategies Based on 10 Cases and Current Literature: Towards a Pragmatic Surgical Algorithm

Yujo Kawashita et al. Cureus. .

Abstract

Obturator hernia is a rare pelvic hernia that predominantly affects elderly, thin women. Despite advances in imaging and surgical techniques, the optimal surgical approach remains controversial. We retrospectively analyzed 10 patients who underwent emergency surgery for an obturator hernia at our institution between January 2010 and August 2024. All patients were female with a median age of 88.9 years (range: 84-97). Six patients (60%) required bowel resection. Seven underwent open repairs, and three underwent laparoscopic transabdominal preperitoneal (TAPP) repair. One patient with perforated peritonitis died postoperatively. During a median follow-up of 32 months (range: 18-51), one recurrence occurred at 34 months in a patient who had undergone suture repair without mesh reinforcement. Based on our experience and a comprehensive literature review encompassing three systematic reviews/meta-analyses and one nationwide registry study, we propose a treatment algorithm centered on three principles: TAPP as the default approach, bowel viability as the central decision point, and a contamination-based repair strategy. Two illustrative cases demonstrate the clinical application of this algorithm.

Keywords: mesh repair; obstructed obturator hernia; open and laparoscopic surgery; small bowel resection; staged repair; transabdominal preperitoneal (tapp); treatment algorithm.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Fukuoka Seishukai Hospital Ethics Committee issued approval FSHI-IRB-2026-027. This is to certify that the following research protocol has been reviewed and approved by the Institutional Review Board (Ethics Committee) of Fukuoka Seishukai Hospital in accordance with the Ethical Guidelines for Medical and Biological Research Involving Human Subjects (Ministry of Health, Labour and Welfare, Japan). Study Title Obturator Hernia: A Critical Appraisal of Treatment Strategies Based on 10 Cases and Current Literature Principal Investigator Yujo Kawashita, MD Department of Endoscopic Surgery and Hernia Center Co-Investigators Masaki Tateishi, MD; Takashi Ueda, MD Study Type Retrospective observational study (case series) Review Type Expedited review Data Collection Period January 2010 – August 2024 Informed Consent Waived (opt-out method approved) Decision APPROVED Conditions of Approval: 1. As this is a retrospective observational study utilizing existing medical records, the requirement for individual written informed consent has been waived. An opt-out mechanism has been implemented in accordance with national ethical guidelines. 2. All patient data must be anonymized to prevent identification of individual subjects. No identifying information shall appear in any publication. 3. A study completion report must be submitted to the Ethics Committee upon conclusion of the research. This certificate confirms that the above-mentioned research has been conducted in compliance with the Declaration of Helsinki, the Ethical Guidelines for Medical and Biological Research Involving Human Subjects (Japan), and all applicable regulations governing human subjects research. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Case A: Preoperative CT.
(A) Axial view showing right obturator hernia with incarcerated small bowel (arrowhead). (B) Coronal view.
Figure 2
Figure 2. Case A: Operative Findings.
(A) Laparoscopic view of ileal incarceration in the right obturator foramen. (B) Reduction using the water pressure technique. (C) Reduced bowel showing severe ischemic changes. (D) Mesh plug repair after conversion to anterior approach.
Figure 3
Figure 3. Case B: Preoperative CT.
(A) Axial view showing right obturator hernia with incarcerated terminal ileum (arrowhead). (B) Coronal view.
Figure 4
Figure 4. Case B: TAPP Repair.
(A) Laparoscopic view of ileal incarceration. (B) After reduction, the bowel showed mild ischemia with prompt color recovery. (C) Preperitoneal dissection. (D) Flat mesh (15×10 cm) covering the obturator foramen and inguinal regions.
Figure 5
Figure 5. Treatment Algorithm.
Laparoscopy is the first choice when feasible. Bowel viability is assessed by color, peristalsis, mesenteric pulsation, and bleeding. Repair strategy depends on contamination grade (CDC classification). Staged mesh may be omitted in patients with limited life expectancy. TAPP: transabdominal preperitoneal repair; CDC: Centers for Disease Control and Prevention. Figure created by the authors.
See this image and copyright information in PMC

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