単孔式腹腔鏡下鼠径ヘルニア修復術における縫合・結紮の工夫

Single-incision laparoscopic transabdominal preperitoneal inguinal hernia repair （SI-TAPP） with newly developed suturing and ligation techniques

◆要旨：Transabdominal preperitoneal approach（以下，TAPP）の利点は，気腹によるすべてのヘルニア門を確認し，同時に修復可能であることなどが挙げられる．一方，近年，単孔式腹腔鏡下手術が急速に広がり，鼠径ヘルニア修復術にも行われるようになってきているが，技術的難易度が高くTAPPでは腹膜修復に難渋することが多い．筆者らはParietex ProGrip^TM meshを使用しtackingをなくすことを可能とし，tackingに起因する合併症をなくすことを可能とした．さらには腹膜修復に独自の工夫をすることにより腹膜修復にかかる手術時間の短縮を可能にしたため，その手術手技を報告する．

　Transabdominal preperitoneal inguinal hernia repair （TAPP）, which is one of the laparoscopic inguinal hernia repair procedures, enables visualization of both sides of the inguinal region. This procedure allows simultaneous confirmation and pneumoperitoneum-based repair of all hernia orifices. Recently, laparoendoscopic single site surgery （LESS） has become widespread, especially for cholecystectomy and appendectomy. LESS provides much better cosmetic outcomes so-called scar-less surgery, which ensure higher patient satisfaction. Laparoscopic inguinal hernia repair procedures, including TAPP, are suitable for LESS. However, single-incision TAPP （SI-TAPP） is not performed frequently because it requires a highly complex operation. We performed SI-TAPP in patients with symptomatic inguinal hernia by using our newly developed technique. The Parietex ProGripTM mesh contains a self-gripping mechanism and may not require tacking. As a result, complications related to tacking, such as bleeding, nerve damage, and chronic pain, can be avoided. Further, this non-tacking method also requires very few medical devices, which reduces the overall cost of the procedure. Although the SI-TAPP is a technically difficult procedure, especially suturing the peritoneum and ligature, the operative time can be easily reduced by repairing the peritoneal tissue with the Loop & LTH ligation technique that was developed by our group. In comparison with the conventional TAPP methods, the non-tacking SI-TAPP and Loop & LTH ligation technique offered the advantages of lesser foreign material and lower cost of medical devices. Moreover, our Loop & LTH ligation technique is an optimal technique for peritoneal repair with SI-TAPP.