Emergency Single-Incision Laparoscopic Surgery With Loop-Assisted Peritoneal Inversion Closure (SILS-LAPIC) for Strangulated Obturator Hernia With Small Bowel Necrosis

Obturator hernia is a rare pelvic hernia that predominantly affects elderly, thin women and often presents as small bowel obstruction requiring emergency surgery. Although mesh repair reduces recurrence, placing mesh in a potentially contaminated field may be inadvisable when the acutely irreducible bowel is necrotic. We report an 87-year-old woman with an acutely irreducible right obturator hernia causing small bowel obstruction; intraoperative findings confirmed strangulation with focal bowel necrosis. Emergency repair was performed through a single-incision laparoscopic surgery (SILS) approach. The bowel was reduced using a water-jet technique, and mesh was not used because of the focal necrosis. The right obturator defect was closed by peritoneal inversion and ligation with a pre-tied ligature loop (Endoloop; Ethicon, Somerville, NJ, USA), a mesh-free technique termed loop-assisted peritoneal inversion closure (LAPIC); an occult left obturator hernia was closed prophylactically using the same technique. We designate this combined strategy SILS-LAPIC. The affected bowel was exteriorized through the same umbilical incision, allowing direct visual assessment and limited wedge resection of the necrotic segment. Operative time was 64 minutes, and blood loss was 1 mL. The patient resumed oral intake on postoperative day 2 and was discharged on day 5 without complications, including obturator nerve palsy, with no recurrence at three months. SILS-LAPIC may be a feasible emergency option for selected patients with strangulated obturator hernia and limited bowel necrosis.