Purpose <p>To compare the benefits of ultrasound-guided reduction (UGR) followed by elective versus emergency repair for incarcerated obturator hernia (OH).</p> Methods <p>This is a retrospective cohort study. Before UGR implementation, all patients with incarcerated OH underwent emergency surgery. To compare the UGR candidates fairly, only patients who did not require bowel resection were classified as the emergency group. Following UGR implementation, the patients without bowel necrosis, based on our criteria, underwent UGR. Among these, those who underwent elective repair were classified into the elective group. The surgical outcomes were compared between the groups and are presented as the median (range).</p> Results <p>Among the 60 patients with incarcerated OH, 23 were in the emergency group and 11 in the elective group. UGR was successful in 16 of 17 cases (94%). The elective group had significantly shorter times to first defecation (4 [1–7] vs. 0 [0–1]) and meal initiation (3 [1–8] vs. 1 [1–3] days) than the emergency group. Although not statistically significant, the mesh repair rate was higher in the elective group (100% vs. 78%, respectively).</p> Conclusions <p>UGR can be safely performed with an appropriate diagnosis. Compared with emergency surgery, UGR followed by elective repair led to reduced postoperative ileus and elevated mesh repair rates.</p>