腹壁瘢痕ヘルニアに対する腹腔鏡下修復手術

Laparoscopic incisional hernia repair

◆要旨：腹壁瘢痕ヘルニアに対しての開腹による修復術は高頻度に認められるヘルニアの再発や感染，疼痛といった合併症が問題であった．今回，筆者らはメッシュを用いて腹腔鏡下に修復術を行った．腹腔鏡下手術の利点には，腹腔内からヘルニアの全貌を確認できる，underlay mesh repairが可能である，筋膜の剝離が不要，術後感染の減少が期待できる，肥満患者でも小さな切開創で手術が可能である，などがある．ただし，腹腔鏡下手術が保険適用となっていないことや腹壁への固定の方法など問題点もある．

　In open ventral incisional hernia repair, complications such as recurrence, infection, and pain occur frequently. We performed laparoscopic ventral incisional hernia repair by using the mesh. The advantages of this operation are that the entire hernia can be confirmed from the abdominal cavity, underlay mesh repair is possible, exfoliation of the fascia is unnecessary, a decrease of postoperative infection can be expected, and an obese patient may also be operated from a small incision layer. However, there still remain some problems regarding this surgery. Laparoscopic surgery is not covered by insurance and the methods of fixing to the abdominal wall are problematic.