多次手術患者に対する腹腔鏡補助下幽門側胃切除術の工夫

Technical tips for laparoscopy-assisted distal gastrectomy after a laparotomy for intestinal obstruction and abdominal incisional hernia

◆要旨：近年，腹腔鏡下胃切除術の普及に伴い，初期には適応外とされていた開腹手術既往例に対しても腹腔鏡下で行われるようになってきた．しかし，開腹手術既往例に対しては，腹腔内の癒着が高度な場合に腸管損傷などの偶発症の危険性が高くなるために慎重な手術操作が必要である．今回，筆者らは腹壁瘢痕ヘルニアを伴う腸閉塞術後に早期胃癌に対し腹腔鏡補助下幽門側胃切除術（laparoscopy-assisted distal gastrectomy；以下，LADG）を施行し良好な経過を得た．術後の呼吸器合併症や腹壁瘢痕ヘルニア再発を防止するために腹壁破壊を最小限に抑えるという点でLADGは非常に有用であり，手術に際する工夫を含めて報告する．

　In recent years, laparoscopic gastrectomy has become more widely used and has begun to also be performed for patients with a history of laparotomy, for whom the procedure had initially not been indicated. However, for these patients, the surgery must be carefully performed due to the increased risks of complications such as intestinal injury in cases of severe adhesions in the abdominal cavity. In the present study, we obtained a favorable outcome after performing laparoscopy-assisted distal gastrectomy（LADG）for early gastric cancer in a patient who had undergone surgery for intestinal obstruction with abdominal incisional hernia. LADG is extremely useful as it prevents postoperative respiratory complications as well as recurrence of abdominal incisional hernia and minimizes damage to the abdominal wall.