@article{3120075,
    title = "Obturator hernias: a systematic review of the literature",
    author = "Schizas, D. and Apostolou, K. and Hasemaki, N. and Kanavidis, P. and Tsapralis, D. and Garmpis, N. and Damaskos, C. and Alexandrou, A. and Filippou, D. and Kontzoglou, K.",
    journal = "Revista Hispanoamericana de Hernia",
    year = "2021",
    volume = "25",
    number = "1",
    pages = "193-204",
    publisher = "Springer-Verlag Italia s.r.l.",
    issn = "2255-2677",
    doi = "10.1007/s10029-020-02282-8",
    keywords = "abdominal pain;  abdominal radiography;  abdominal wall hernia;  body mass;  computer assisted tomography;  conversion to open surgery;  emergency surgery;  fever;  gold standard;  hernioplasty;  hospitalization;  human;  intermethod comparison;  intestine obstruction;  intestine resection;  Kaplan Meier method;  laparoscopic surgery;  length of stay;  log rank test;  logistic regression analysis;  morbidity;  mortality rate;  nausea;  obturator hernia;  open surgery;  outcomes research;  perioperative period;  preoperative evaluation;  priority journal;  proportional hazards model;  recurrence risk;  Review;  surgical approach;  surgical mortality;  surgical technique;  survival analysis;  symptom;  systematic review;  treatment outcome;  univariate analysis;  vomiting;  herniorrhaphy, Hernia, Obturator;  Herniorrhaphy;  Humans",
    abstract = "Purpose: Obturator hernias (OH) are extremely rare hernias, accounting for 0.07–1% of all hernias. This is the first systematic review investigating their presentation, imaging, treatment outcomes, and recurrence rate. Methods: After a detailed search in electronic search engines, 74 studies matched our criteria. A review of these reports was conducted and the full texts were examined. Results: A total of 146 patients with a mean age of 78.8 years were included in our analysis, with 40.1%, 29.9%, and 25.2% of patients suffering from either a right, a left or bilateral OH, respectively. OH were associated with non-specific symptoms and signs; bowel obstruction being the most common. Howship–Romberg sign was present in 56.2% of patients. Computed tomography (CT) scan was the most frequently used diagnostic modality, inversely associated with perioperative mortality. Mesh repair demonstrated a significantly improved perioperative morbidity rate, compared with non-mesh repair. Approximately 30% of patients underwent a laparoscopic operation, which was associated with significantly decreased morbidity and mortality rate as well as length of hospital stay, compared with the open repair. Conclusion: OHs are not associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair. © 2020, Springer-Verlag France SAS, part of Springer Nature."
}