Ultrasound-guided manual reduction for incarcerated obturator hernia: a bridge to elective surgery or a pragmatic non-operative strategy.

Abstract

Purpose: We evaluated ultrasound-guided manual reduction as an initial management strategy for incarcerated obturator hernia, both as a bridge to elective surgery and as a pragmatic non-operative option in severely frail patients.

Methods: We retrospectively analyzed consecutive patients who underwent attempted manual reduction for incarcerated obturator hernia between 2012 and 2025, excluding those with suspected bowel necrosis. The reduction success, associated factors, and subsequent outcomes were assessed.

Results: Manual reduction was successful in 39/46 lesions (84.8%) without procedure-related complications. Early presentation tended to be associated with successful reduction (median 12 vs. 48 h, p = 0.057). Compared with emergency surgery after failed reduction (n = 7), elective surgery following successful reduction (n = 24) was associated with lower bowel resection rates (0% vs. 42.9%, p = 0.008), higher mesh use (100% vs. 57.1%, p = 0.008), and a shorter postoperative stay (4 vs. 12 days, p = 0.002). Among the eight severely frail patients managed non-operatively, seven (87.5%) met the predefined clinical endpoints.

Conclusion: Ultrasound-guided manual reduction appears to be feasible in selected patients with incarcerated obturator hernia, serving as a bridge to elective mesh repair under favorable conditions. In carefully selected severely frail individuals, it may also represent a pragmatic non-operative management option.