Manual reduction in minimally invasive management of obturator hernia: a retrospective study

Incarcerated obturator hernias, rare but serious, often require emergency surgery in elderly patients having poor health. In recent years, several studies have reported that manual reduction under imaging guidance may facilitate less invasive, elective laparoscopic repair. However, the clinical significance of successful manual reduction in terms of surgical strategy and postoperative outcomes remains unclear. We retrospectively reviewed 35 incarcerated obturator hernia cases treated at our institution between 2016 and 2025. Ultrasound-guided manual reduction was attempted in all cases. The success of reduction was confirmed using post-reduction computed tomography (CT) imaging. Patients were then classified into two groups: the reduction success group (n = 14) and the failure group (n = 21). We compared the patients’ backgrounds, surgical approaches, bowel resections, mesh usage, and postoperative outcomes between the groups. Laparoscopic repair was more frequent in success group (43% vs. 5%, P = 0.04). Bowel resection was not required for success group patients but was necessitated in 53% of failure group patients (P = 0.02). Mesh usage was higher in success group (100% vs. 29%, P = 0.001). No manual reduction-related complications were noted. Severe postoperative complications (Clavien–Dindo ≥ grade III) were more frequent in failure group (29% vs. 0%). Ultrasound-guided manual reduction appeared safe in our cohort and was associated with a higher feasibility of elective surgery and laparoscopic mesh repair, with lower rates of bowel resection and severe postoperative complications. Reduction success may serve as a practical marker to guide surgical planning, although causal inference is limited by the retrospective design.