Pfannenstiel切開を用いた臍を避けたポート配置による腹腔鏡下右側結腸切除と体腔内吻合

Intracorporeal anastomosis followed by laparoscopic right colectomy using Pfannenstiel incision for right-sided colon cancer

◆要旨：腹壁瘢痕ヘルニアを減少させる目的で，正中を避けた切開創が推奨される．臍を避けたポート配置による腹腔鏡下右側結腸切除と体腔内吻合の手技について報告する．cT3以下の結腸癌15例に適応し，肥満体型は6例，腹部手術既往は8例に認められた．恥骨上3横指の高さにPfannenstiel切開を行い，同部よりカメラポートを挿入する．他のポートは臍から離して平行四辺形型に配置する．全例で体腔内機能的端々吻合を選択した．術後腹腔内膿瘍が1例に認められた．全例で再発や腹壁瘢痕ヘルニアは認められていない．本法は腹壁瘢痕ヘルニアの併発率が高い臍部正中切開を避けつつ，肥満や手術既往のある症例でも安全に施行可能である．

　European and American Hernia Society guidelines suggests avoiding a midline incision for laparotomies and specimen extraction sites to reduce the risk of postoperative incisional hernias. Here, we describe a novel technique for intracorporeal anastomosis followed by laparoscopic right colectomy that uses a Pfannenstiel rather than midline umbilical incision in patients with right-sided colon cancer. All procedures were performed after mechanical and chemical preparation. The first port was inserted through a suprapubic Pfannenstiel incision, while the other four ports were placed in a parallelogram formation away from the umbilicus. An anti-peristaltic side-to-side stapled anastomosis（functional end-to-end anastomosis）was performed intracorporeally in all cases. A laparoscopic right colectomy using this technique was performed on 15 patients with cT3 or lower right-sided colon cancer, including six patients with obesity and eight with a history of previous abdominal surgery. The median duration of surgery for intracorporeal anastomosis in laparoscopic right colectomy was 11min（range, 10-17min）, An intra-abdominal abscess was observed in only one case. Despite a lack of long-term follow-up, there have been no cases of postoperative recurrence or incisional hernias. This approach is safe and avoids a midline umbilical incision, thereby having potential of reducing the risk of postoperative incisional hernia.