Manual reduction yields useful results in Hernia patients

Emergent surgery is a common approach for incarcerated obturator hernias,
with high morbidity and mortality rates. Moreover, there have been reports
of elective surgery cases after noninvasive manual reduction. For a
decade, the initial approach on manual reduction unless bowel viability is
poor.
This study aimed to clarify the efficacy and safety of manual
reduction followed by elective surgery. “We retrospectively reviewed 50
cases of incarcerated obturator hernia from 2010 to 2022 at Iwate
Prefectural Iwai Hospital. Manual reduction was attempted in 31 (62%)
patients”, experts said.
The reduction was successful in 21 (42%) patients, and most of them
received mesh repair using the extraperitoneal approach as elective
surgery. However, two patients underwent emergent surgery in the waiting
period because of late-onset constriction and a small bowel perforation.
Patients with irreducible hernia underwent emergent surgery, except for two
patients who received the best supportive care. Postoperative complications
were observed in 5% and 22% of reducible and irreducible cases,
respectively. Postoperative mortality was zero in both groups.

Manual reduction is useful in many cases, but careful observation is needed
because late-onset constriction and perforation could occur.