鼠径ヘルニアTEP術後の難治性疼痛に対し腹腔鏡下メッシュ摘除術を施行した1例

Intractable postoperative pain following TEP inguinal hernia repair, treated by laparoscopic 3 D mesh resection

◆要旨：患者は30歳代の女性．両側鼠径ヘルニアの診断にて当科で腹腔鏡下両側鼠径ヘルニア根治術（totally extraperitoneal repair：以下，TEP法）を施行し，第4病日に軽快退院した．術後2か月より右下腹部痛が出現し徐々に増強したために当科を再診した．鎮痛剤内服にて疼痛はいったんは自制内となっていたが，術後5か月目より再び増悪し，また疼痛部位が限局しておりメッシュ固定に用いたステイプル部と一致することから，ステイプル関連痛の診断にて腹腔鏡下3Dメッシュ摘除術を施行したところ，術後速やかに疼痛が消失した．TEP術後の疼痛を減少させるために，今後はメッシュ固定にステイプルを使用しない術式選択も必要であると考えられた．

　We reported a case of intractable postoperative pain treated by laparoscopic 3 D-mesh resection. The patient was a woman in her thirties who underwent laparoscopic TEP inguinal hernia repair. She complained of right lower abdominal pain two months after operation. Although this pain improved temporarily by NSAIDs medication, the analgesic was ineffective five months after operation. We diagnosed staple-related pain following TEP repair because the pain was localized just above the fixed staple. We performed laparoscopic 3 D-mesh resection, and the intractable pain disappeared immediately after operation. Accordingly, it is considered that laparoscopic TEP inguinal hernia repair without' additional mesh fixation may be able to reduce postoperative pain.