A Case of Laparoscopic Transabdominal Pre-peritoneal Hernia Repair Using a 3D Mesh Inversion Technique for Bilateral Obturator and Femoral Hernias After Incarcerated Obturator Hernia Reduction

An obturator hernia (OH) is a rare type of hernia that accounts for a very small proportion of all hernias and cases of small bowel obstruction. This condition predominantly affects older, underweight individuals, with the vast majority of patients being women. Laparotomy with simple suture closure of the defect is commonly used as surgical treatment for OH. However, the closeness of the obturator nerve to the obturator defect causes difficulty in observing this nerve due to the deep operative field in laparotomy. Thus, transabdominal pre-peritoneal hernia repair (TAPP) has advantages over an open approach, and TAPP is now commonly performed for OH. In the case described here, an 86-year-old female patient presented with lower abdominal pain and vomiting. Abdominal computed tomography revealed a right-sided OH causing intestinal obstruction, and the patient was referred to our hospital. Her medical history included hypertension, dementia, and an artificial head replacement for a left femoral neck fracture. Laboratory tests showed elevated white blood cell (WBC) of 13,700/μL, but other results were normal. Manual reduction of the hernia was successful, leading to symptom improvement, and the patient was admitted for observation. She was discharged on day three after admission. After one month, laparoscopic TAPP was performed. Bilateral OHs and femoral hernias were observed. Using a recently proposed 3D mesh inversion technique, the mesh was fitted anatomically for the OH. This is the first reported case of elective TAPP using a 3D MAX^TMLight Mesh (Bard, Warwick, RI, US) with an inversion technique for bilateral OH and femoral hernia after incarcerated OH reduction.