An 84-year-old woman was seen at the hospital because of radiating pain from the left inguinal region to the left thigh. A pelvic CT scan showed an oval-shaped intestine between the left pectineal muscle and the external obturator muscle, and left obturator hernia was diagnosed. Because the hernia was spontaneously reduced, elective surgery by extraperitoneal approach through an inguinal region was performed. A skin incision was made similar to the approach for inguinal hernia and a hernia sac impacted into the left obturator foramen was seen. There was no hernia content so that the hernia sac was reduced by hands. The hernia orfice was 1 cm in diameter. A 4 × 3 cm oblong inlay graft of Marlex mesh was sutured with the superior ramus of pubis and internal obturator muscle so as to cover the obturator foramen, in the meantime careful attention was paid for the obturator nerve, artery and vein. The hernia orfice was thus covered. The patient's postoperative course was uneventful and she was discharged from the hospital on the 8th postoperative day.
This repair using an inlay graft of Marlex mesh is a safe and reliable repair for obturator hernia, because it is minimally invasive, it does not give any tension to the surrounding organs, and it does not compress the obturator nerve, artery and vein. The approach is considered to be very useful for cases of obturator hernia which are candidates for elective surgery and have no risk of intestinal necrosis.