術後再発したupside down stomachに対し腹腔鏡下修復術および胃固定・胃瘻造設術を施行した1例

Laparoscopic repair and laparoscopic-assisted gastrostomy for postoperative recurrent hiatal hernia with an upside-down stomach : A case report

◆要旨：症例は76歳，女性．統合失調症で当院精神科に長期入院中の患者．2年前に当院でupside down stomachに対し腹腔鏡下食道裂孔ヘルニア修復術（Toupet法）を施行した既往がある．今回，急激な腹痛を訴えたためCT検査を実施したところupside down stomachを呈しており再発していた．上部消化管内視鏡検査では整復困難であり緊急手術加療とした．腹腔鏡にて手術を開始し脱出した胃は容易に腹腔内へ還納できた．裂孔開大部を再度縫縮し，再発を防ぐために尾側方向に牽引した状態で有棘縫合糸を用いて胃大彎側前壁を腹壁に固定する胃固定術と胃瘻造設を行った．術後経過は良好で合併症はなく，胃瘻は3か月後に抜去した．術後2年経過した現在再発なく経過している．

　A 76-year-old woman with a history of schizophrenia and long-standing hospitalization in the Department of Psychiatry at our hospital underwent laparoscopic Toupet partial fundoplication for management of an upside-down stomach, 2 years prior at our hospital. Currently, she presented with sudden onset of abdominal pain, and computed tomography revealed recurrence of the upside-down stomach. Endoscopic repositioning was attempted; however, untwisting of the gastric volvulus was challenging, and we performed emergency surgery. Using a laparoscopic approach, the pylorus was easily returned into the abdominal cavity. The esophageal hiatus was re-sutured, and laparoscopic anterior gastropexy using a barbed suture with caudal traction and laparoscopic-assisted gastrostomy were performed to prevent recurrence. The patient had a good postoperative course without complications, and the gastrostomy tube was removed 3 months postoperatively. The patient had no recurrence, 24 months postoperatively.