Hybrid TAPP/TEP Repair of Bilateral Obturator and Inguinal Hernias

Introduction: Obturator hernias represent a rare cause of small-bowel obstruction. When diagnosed on computed tomographic (CT) scan in a stable patient, timely surgical repair is indicated. Because of the absence of large-scale studies, the ideal operative approach has yet to be defined. Case Description: A 75-year-old woman presented to the emergency department with an incarcerated left-side obturator hernia manifesting as a small-bowel obstruction. The hernia was diagnosed on CT scan, and the patient was taken to the operating room for laparoscopic reduction and repair. During surgery, a contralateral obturator hernia and bilateral indirect inguinal hernias were discovered. Hybrid transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) approaches were used to reduce and demonstrate the viability of the incarcerated bowel and then to repair all 4 defects with mesh. The procedure was well tolerated, and the patient was discharged uneventfully after the return of bowel function. Discussion: This case provides an example of how a hybrid TAPP/TEP laparoscopic approach can be effective for visualizing and repairing an obturator hernia as well as an incidentally discovered inguinal hernia.