閉鎖孔ヘルニアを伴う膀胱ヘルニアの腹腔鏡下腹膜外修復術：対側3D Maxメッシュを用いた一例報告

Obturator hernia is an uncommon condition. With the widespread adoption of laparoscopic surgery, incidental detection of obturator hernias has become increasingly frequent. Bladder herniation through the obturator foramen is extremely rare, with only 14 cases reported to date. Herein, we describe a rare case of obturator bladder hernia successfully repaired via the laparoscopic transabdominal preperitoneal (TAPP) approach, highlighting a novel technical modification.

A 74-year-old female was diagnosed with an obturator bladder hernia. The patient initially presented to the hospital with hematochezia and was diagnosed with ischemic colitis. Initial CT revealed an obturator hernia in the small intestine. The following day, CT revealed an obturator bladder hernia, although she had no symptoms related to an obturator bladder hernia. Subsequent CT at our hospital established a diagnosis of obturator bladder hernia. The patient underwent laparoscopic obturator hernia repair via the TAPP approach. A contralateral 3D MAX MID Anatomical Mesh (Bard; Warwick, RI, US) was deployed. The mesh was rotated 180° around its medial axis and positioned with the convex surface facing the abdominal wall to achieve an optimal anatomical fit. The operative time was 148 minutes, with an estimated blood loss of 10 mL. The postoperative course was uneventful, and the patient was discharged on the 3rd POD.

Currently, there is no clear consensus regarding the surgical indications for obturator bladder hernia. In the present case, although the patient was asymptomatic, daily changes in hernia contents raised concerns regarding potential small bowel incarceration, prompting surgical intervention. Our novel modification of the TAPP approach involved the placement of a contralateral 3D MAX mesh rotated 180° around its medial axis. This adjustment preserved the anatomical curvature of the mesh, facilitated secure fixation, and ensured adequate coverage of the obturator foramen and femoral ring.