拡張バルーンを使用しないTEPP（totally extraperitoneal preperitoneal repair）法の検討

A new technique for securing working space in the preperitoneal space during totally extraperitoneal preperitoneal repair（TEPP）for groin hernia

◆要旨：鼠径部ヘルニアに対するtotally extraperitoneal preperitoneal repair（以下，TEPP）法は腹膜前腔を直視下に観察しながらメッシュを挿入する点できわめて有用な方法であるが，腹膜前腔のworking spaceを確保する方法としては拡張バルーンを使用する方法が一般的と思われる．

　筆者らはTEPP法において膜構造を意識して手術を行うため，2008年から拡張バルーンを使用せず直視下で鋭的に剝離し，working spaceを作製する工夫を行っている．

　今回，筆者らは拡張バルーンを使用した群（以下，従来群）と拡張バルーンを使用しない群（以下，工夫群）を比較し，この手技の有用性について検討した．工夫群で手術時間は約16分延長したが，再発例や嵌頓例にも施行可能であった．術中合併症は従来法群で11例（8.1％）にみられたが，工夫群ではみられなかった．膜構造を意識した直視下剝離法は術中トラブル防止や術後合併症の低下の面でもきわめて有用であり，今後は本術式の標準的手術手技になることが期待される．

　Totally extraperitoneal preperitoneal repair（TEPP）for groin hernia is a very useful surgical technique from the anatomical point of view, because we are able to observe the preperitoneal space directly. We usually use the extended balloon for securing working space in the preperitoneal space in Japan. Since 2008, we started the new technique of securing working space in the preperitoneal space using scissors instead of the extended balloon. We report in detail, the methods of this new technique and the clinical outcome in this paper. Operation time was prolonged for about 16 minutes compared with the group which uses the extended balloon. It was possible to perform this method on cases of recurrence, or cases of strangulation. Although the complications during operation were observed in 11 cases（8.1%）in the group which uses an extended balloon, they were not seen into the group which does not use an extended balloon. This method was very useful also in decreasing trouble during operation, and also postoperative complications. It seems that this method will become the standard operation of totally extraperitoneal preperitoneal repair（TEPP）for groin hernia.