Indications for treatment of incidental obturator hernia encountered during transabdominal preperitoneal repair (TAPP).

Purpose: To clarify indications for treating incidental obturator hernia (IOH) detected during laparoscopic groin hernia repair by comparing features of IOH with obturator hernia (OH) complicated by incarceration.

Methods: Twenty patients who underwent laparoscopic OH repair between January 2017 and July 2024 were included in this retrospective study. They were divided into groups with incarceration or a past history of incarceration (the OH group) or without incarceration (the IOH group). Univariate analysis was performed, and ROC curves were constructed with the cut-off values representing indications for treating IOH.

Results: Thirteen patients comprised the IOH group (bilateral in one), while seven comprised the OH group (all unilateral). Univariate analysis selected high age, low body mass index (BMI), and a large orifice as risk factors for incarceration. Cut-off values of these variables were age 89 years (area under curve, 0.816), BMI 17.7 kg/m² (0.939), and orifice diameter 12 mm (0.796). Age of at least 89 years and BMI of 18 or less were more common in the incarceration group (P = 0.004, P = 0.007), and all patients in the incarceration group had orifices at least 12 mm in diameter. Assigning the 3 variables 1 point each, the OH group had significantly higher scores of at least 2 points (P < 0.001).

Conclusion: High age, low BMI, and large orifice diameter may be considered useful indicators for treating IOH. Two or more of these factors could place a patient at high risk for incarceration and show need for treatment of IOH.