2022 Volume 55 Issue 1 Pages 1-9
Purpose: Incarcerated obturator hernia often requires emergency surgery and has a poor prognosis with a high mortality rate. We devised a repositioning maneuver for this condition that we refer to as “Four hand Reduction for incarcerated Obturator hernia under Guidance of Sonography (FROGS)” and here we report this procedure and its advantages. Materials and Methods: FROGS requires a surgeon and an assistant, and use of sonography. The surgeon detects the tip of the hernia sac with sonography. The assistant holds the patient’s leg on the lesion side, and bends, stretches or rocks it inward and outward, slowly and repeatedly. Meanwhile, the surgeon manually compresses the tip of the hernia sac under observation with sonography. Thirty-six patients with incarcerated obturator hernia were treated at our hospital between April 2016 and September 2020. FROGS was introduced in November 2019. The patients were divided into those treated before and after introduction of FROGS. The rates of successful reduction, bowel resection, complications, and mortality, and the length of hospital stay were retrospectively compared between the non-FROGS and FROGS groups. Results: There were 13 patients in the FROGS group and 23 in the non-FROGS group. There were no significant differences in patient characteristics between the two groups. Successful reduction was achieved in all patients in the FROGS group (100%), but in only one patient in the non-FROGS group (4.3%) (P<0.001). The rate of bowel resection was significantly lower in the FROGS group than in the non-FROGS group (P=0.03). The FROGS group had lower rates of complications and mortality and a shorter hospital stay than the non-FROGS group, although without significant differences. Conclusion: FROGS is a useful repositioning maneuver for incarcerated obturator hernia that has advantages of simplicity and reproducibility.
