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Diagnosis and Laparoscopic Repair of
Type I Obturator Hernia in Women With
Chronic Neuralgic Pain
C. Paul Perry, MD, Jeffrey M. Hantes, DO
ABSTRACT
Background:
We performed a pilot study review of 7 female patients suffering with obturator neuralgia produced by a type I obturator hernia.
Diagnosis and laparoscopic treatment of this rare hernia are presented.
غلاف 4 میلی متری با نوک تیز
Methods:
Patients with chronic pelvic pain and signs of obturator neuralgia were identified retrospectively by chart review.
These patients had been referred to our chronic pelvic pain clinic.
Outcomes of their surgery from February through November 2001 were analyzed.
Median length of follow-up was 11 months (range, 6 to 16).
A new technique using Cooper’s ligament and arcus tendineus fasciae pelvis was used for the tension-free mesh hernia repair.
شیت4میلیمتری باابتراتورنوک تیز
Results:
In this pilot study, 6 of 7 patients (86%) received
greater than 50% relief of their chronic pelvic pain, which
leads to the conclusion that we have at least 95% confidence that the pain reduction achieved is greater that 50%.
Due to the small sample size, no statistically meaningful
conclusions could be reached.
All of the patients have
reported some pain relief and increased function since
surgery.
Conclusion:
Symptomatic type I obturator hernias may
be more common than previously thought. Patients with
obturator neuralgia, persisting longer than 6 months despite conservative therapy, may respond to laparoscopic
reduction of the pilot fat tag and mesh overlay of the
obturator canal.
غلاف 4 میلی متری با نوک تیز
Key Words:
Obturator hernia, Obturator neuralgia, Laparoscopic hernia repair.
INTRODUCTION
The obturator foramen is the largest in the human body.
It is formed by the rami of the ischium and the pubic bone.
The foramen is partially closed by a strong musculoaponeurotic barrier consisting of an internal and an external
obturator membrane and an internal and an external obturator muscle.
The obturator canal is situated in the
cranial portion of this membrane with the pubic bone
above and the membrane below.
This tunnel measures
approximately 0.2-cm to 0.5-cm wide and 2-cm to 3-cm
long through which traverse the obturator nerve, artery,
and vein.
Obturator hernia (OH) formation was first described by Ronsil in 1724.1 Although it is considered a relatively rare hernia (0.07% of all hernias), it is the most common in the pelvic floor (obturator, sciatic, and perineal).
Three types of obturator hernias have been described based on the anatomical defect that is present.
شیت4میلیمتری باابتراتورنوک تیز
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