Obturator Foramen Bypass: Long Term Results of a French Case Series

Introduction: Obturator foramen bypass (OFB) is an extra-anatomic lower limb revascularisation technique useful in hostile groin cases. Although described during the 1960s, this operation is often considered technically demanding and not widely used nowadays. This study reports the long term outcomes of a series of OFBs. Method: This was a retrospective, observational, single centre study. All consecutive patients who underwent an OFB between 2002 and 2024 at the Henri Mondor University Hospital were included. Pre-operative patient characteristics, as well as intra-operative and post-operative data were analysed. Primary outcomes were survival and primary and secondary patency. Secondary outcomes were wound healing, freedom from re-infection, and limb salvage. Results: Between 2002 and 2024, 26 patients underwent an OFB; 18 were men (69%). The mean age was 64 ± 12 years. In 21 cases (81%) the surgical indication was extensive groin infection with native vessels or prosthetic material involvement. In six cases (23%), the operation was performed under emergency conditions. A cryopreserved arterial allograft was the conduit of choice in 16 cases (62%). Mean follow up was 37 ± 8 months (range, 0–129). The thirty day mortality rate was 15%. Survival rate at 12, 24, and 36–60 months was 73%, 67%, and 60%, respectively. The primary patency rate was 88% at 12 months and 83% at 24–60 months. An early re-intervention was needed in eight patients (31%), mostly for local wound debridement. There were no cases of bypass re-infection requiring removal. Conclusion: Obturator foramen bypass can be a limb and lifesaving procedure in selected cases and experienced centres. Long term patency and wound healing rates are satisfactory. The authors reported a non-negligible early mortality rate, which is associated with the severe initial condition of these patients, often admitted with septic or haemorrhagic shock, and affected by multiple comorbidities. Thorough knowledge of the technique and continuous post-operative follow up are mandatory to eventually prevent and treat complications.