Key principles
• Rare hernia through obturator canal presents as lump medial thigh • Most occurs in females >50, generally presents with SBO • Howship-Romberg sign – pain medial thigh on hip extension, internal rotation and adduction of thigh • If diagnosed in elective setting can be repaired laparoscopically via TEP or TAPP approach • Acute repair typically via laparotomy
Specific preoperative preparation
• Urinary catheter
Operation Details
• General anaesthesia, supine • IDUC and NGT if not already present • IVAB on induction • Stand on patients right side • Lower midline laparotomy as per SBO. Run small bowel • Identify hernia and reduce bowel, inspect and resect as required • Reduce peritoneum • Generally either repair with interrupted sutures (can make lateral relaxing incision) or place mesh and cover with peritoneum • Alternative is laparoscopic TEP approach as per inguinal hernia, however dissection needs to be continued down to pelvis and mesh placed in pre-peritoneal position
Relative anatomy
• Obturator canal is passageway from pelvis to medial thigh and is formed by the obturator foremen (between ischium and pubis) and the obturator membrane • Normally transmits obturator NAV which pass medially • Hernia typically between pectineus and obturator externus muscle