単孔式TEPの経験―腹腔内観察併用も含めて―

Single incision TEP combined with intra-peritoneal observation

◆要旨：単孔式腹膜前腔鏡下鼠径ヘルニア修復術（以下，STEP）を15例に行い，再発例，両側例，初発例の9例に腹腔内観察を併用し有用であったので報告する．臍に2cmの縦切開を加えて腹膜を切開し，腹腔内に到達後に腹腔内を観察した．腹膜を仮閉鎖した後，腹直筋前鞘を切開し腹直筋を外側に圧排した．腹直筋後鞘の層に至り，腹膜前腔剝離バルーンを用いて腹膜前腔を剝離した．ヘルニア囊を処理した後に人工パッチを固定した．必要に応じて再度腹腔内観察を行った．手術時間は中央値113分，出血量の中央値9 gで，術後合併症，再発は認めなかった．STEPを安全かつ確実に行うことができた．腹腔内観察の併用はSTEPでも容易であり，特に再発例で有用であった．

　We developed the method of single incision totally extra-peritoneal pre-peritoneal repair （STEP） with or without laparoscopic intra-peritoneal observation. STEP was performed in 15 patients. Laparoscopic intra-peritoneal observation was combined with STEP in 9 patients who had recurrent, bilateral or primary inguinal hernia. A single vertical midline umbilical skin incision 2.0 cm long was used. In the 9 patients, the peritoneum was incised, and laparoscopic intra-peritoneal observation was performed to identify the type of hernia. After temporary closure of the incised peritoneum, the incised anterior sheath of rectus abdominis was pulled aside. Pre-peritoneal space was secured with dilation of the pre-peritoneal distention balloon. Hernia sac was excised, and the repair was made with an artificial patch. Repeated laparoscopic intra-peritoneal observation made it possible to confirm the complete cover of the patch to the hernia ports. The operation time ranged from 82 to 211 minutes （median 113 minutes）. Blood loss during operation was minimal. There were no postoperative complication and recurrence. STEP for inguinal hernia was safe and feasible. Moreover, STEP combined with laparoscopic intra-peritoneal observation was useful and essential especially for patients with recurrent hernia.