Composix MeshⓇを用いて腹腔鏡下にMorgagni孔ヘルニアを修復し得た1例

Laparoscopic repair of a Morgagni hernia using the Composix Mesh : a case report

Ｍorgagni孔ヘルニアは通常無症状に経過するが，本症と診断されば手術治療が原則となる．症例は47歳，女性．2006年1月上旬より労作時呼吸苦を自覚し来院した．胸部X線にて横隔膜ヘルニアを疑われ，2月下旬，当科に紹介され受診となった．胸部X線，CT，MRIおよび注腸検査にてMorgagni孔ヘルニアと診断した．腹腔鏡下に腹腔内を観察すると4×3㎝大のヘルニア門を認め，横行結腸と大網が嵌入していた．ヘルニアstaplerを用いてComposix Mesh^Ⓡをヘルニア門に固定した．経過良好で術後6病日に退院した．従来の開胸・開腹操作と比較し本術式は簡便，低侵襲であり，術後のQOL維持に有用であると思われた．

　Morgagni hernia is a rare type of diaphragmatic hernia, which accounts for 1～3％of all diaphragmatic hernias. A 47-year-old woman who had a dyspnea on effort was referred to our hospital as a diaphragmatic hernia. Chest X-ray, CT, MRI and barium enema were effective diagnostic modalities. At laparoscopy, the patient was placed in a supine, modified lithotomy position. The operator inserted the camera port above the umbilicus with a 12 mm incision, and insufflated CO² gas into the abdominal cavity at low pressure（6 mmHg）. A 4×3 cm oval shaped defect on the right side and a 1×1 cm small defect on the left side were recognized in the anterior aspect of the diaphragm, the transverse colon and part of the omentum were herniated through the right side defect.

　After inserting three working ports into the abdomen, the herniated organs were replaced into the abdominal cavity, and a 10.2×15.2 cm Bard^ⓇComposix Mesh was placed over the defect and fixed to diaphragm using a hernia stapler（Davol^ⓇSalute^Ⓡfixation System）without resecting the hernia sac. Postoperative recovery was uneventful and the patient was discharged on the sixth postoperative day. This technique is easy, safe, curative and minimal invasive to repair Morgagni hernia, therefore should be considered as the first line approach.