単孔式内視鏡下ヘルニア修復術（単孔式TAPP）の導入期における工夫―術式の工夫と従来法TAPPとの成績の比較―

The strategy of single port hernia repair with transabdominal preperitoneal approach for the adult inguinal hernia : review and comparison with conventional transabdominal preperitoneal approach

◆要旨：単孔式内視鏡下ヘルニア修復術（経腹法）（以下，S-TAPP群）を施行した14例，20側の初期導入時における術式の工夫を述べるとともに，2001年から施行した従来法ヘルニア修復術（経腹法）（以下C-TAPP群）の134例，169側を対象として，初発片側，再発片側，両側，前立腺術後症例に分け，手術時間を比較検討した．また術式別に術後入院日数，術後合併症，再発率を比較検討した．結果は全症例，両側症例でS-TAPP群はC-TAPP群より時間延長傾向であった（P＜0.01）が，初発片側では短い傾向であった．再発片側，前立腺術後症例も時間延長の傾向がみられた．入院期間，術後合併症，再発率は両群間に差を認めなかった．S-TAPPの困難症例ではsingle port＋1として時間短縮を計り，合併症，再発の低率化を保つべきである．本法はいまだ時間がかかるものの，従来TAPPと同等の合併症，再発率で整容性に優れ，安全確実な術式になりうると考えられた．

　Hernia repair using single port with transabdominal preperitoneal approach （S-TAPP） was performed in 14 patients （20 sides）. The aim of this study is to review the initial experience and to compare the results of the new method. The assessment was made between this new method and conventional-TAPP （C-TAPP） method that was performed in 134 patients （169 sides） between 2001 and 2010. Patients' background, operation time, hospital stay after surgery, complication and recurrent rate were compared. In patients with primary unilateral hernia, the operation time of S-TAPP group （94.0±16.4 min.） was similar to C-TAPP group （106.6±32.5 min.）. The operation time of S-TAPP group tended to be longer than C-TAPP group in bilateral hernia patients （P<0.1） as well as for those with recurrent unilateral hernia and those who underwent prostate operation. Post operative hospitalization （S-TAPP : 3.00±0.39 days VS C-TAPP : 3.36±1.25 days） and complication rate （S-TAPP : 7％ VS C-TAPP : 7.5％） were similar for both groups. No recurrence occurred in either group. Single port-TAPP was feasible and this method is considered to be safe, steady and more cosmetic for adult inguinal hernia patients.