Treatment of the hostile groin: 5-year follow-up of the obturator foramen bypass

Abstract Background Infection in the groin threatens both life and limb. In recent times virulent organisms, especially methicillin-resistant staphylococci, have proved difficult to treat. The obturator foramen bypass, although performed infrequently, represents an extra-anatomical solution to the ‘hostile groin’. The aim of the study was to examine the primary and secondary graft patency rates in 26 patients (28 procedures) performed in one hospital over 10 years. Methods There were 17 men and nine women with mean age of 65 (range 49–78) years. All procedures except one were performed with expanded polytetrafluoroethylene (6 mm in 24 patients; 8 mm in three). Twenty-one patients had critical ischaemia with rest pain or tissue loss. The inflow vessel was the common iliac artery in 25 patients and the lower abdominal aorta in three. The distal anastomosis was to the profunda in two grafts, to the suprageniculate popliteal artery in 24 grafts and to the infrageniculate popliteal in two. Results Patency rates were calculated with the Kaplan–Meier life-table method. There were nine primary failures (five in the first year and the remaining four between 2 and 5 years). All failed bypasses were re-explored. Three of nine bypasses required intraoperative angioplasty of the inflow, and one graft had angioplasty of the distal anastomosis. Six patients eventually had amputations, four above knee and two below knee, one of whom had a patent graft. Conclusion The obturator foramen bypass, although technically demanding, is a viable solution in the individual with groin sepsis and ischaemia. Frequently these patients have good calibre vessels above and below the problem groin.