コンポジックスメッシュTMと吸収性タックを使用した腹腔鏡下腹壁瘢痕ヘルニア根治術の1例

A case of an incisional hernia operated on by laparoscopic mesh repair with ComposixTM mesh and absorbable tack

◆要旨：患者は70歳，女性．5年前に上行結腸癌に対して前医で腹部正中切開による開腹右半結腸切除を受けた．術後6か月頃から腹壁瘢痕ヘルニアを生じた．今回，腹壁瘢痕ヘルニアで当科を受診した．臍下部から創下端に10×8cmのヘルニア門を触知した．腹腔鏡下に手術を行った．20.3×15.2cmのコンポジックスメッシュ^TMを腹腔内に挿入した．2-0ナイロン糸で4か所を腹壁に仮固定した後，吸収性タック20個を使い腹壁に固定した．術後経過は良好で，術後2日目から食事を開始し，術後7日目に退院した．本法は，X線に映る金属製の異物を体内に残すことのない有用な方法であると考えられた．

　A 70-year-old woman came to our hospital because of abdominal pain. She had undergone an open right hemicolectomy for ascending colon cancer 5 years ago. Six months after the operation, she had an incisional hernia. She came to our hospital because of hernia incarceration. The reduction was easily performed. The hernia orifice was 10 cm in length and 8 cm in width below the umbilicus. We performed laparoscopic operation for the hernia. We used a Composix^TM mesh 20.3 cm in length and 15.2 cm in width. After provisory fixation of the mesh to the abdominal wall with four 2-0 nylon sutures, we used a tacker with 20 absorbable tacks. Tacking was easy and strong enough. Her postoperative course was good and she was discharged on the 7^th postoperative day. She has had no recurrence of hernia to date. Absorbable tacks are useful for the repair of incisional hernia with Composix^TM mesh without radioopaque materials.