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JOURNAL OF JAPAN SOCIETY FOR ENDOSCOPIC SURGERY Volume 17, Issue 3 （June 2012）

日本内視鏡外科学会雑誌 17巻3号（2012年6月発行）

Japanese English

症例報告

単孔式腹腔鏡下手術により治療した腹壁瘢痕ヘルニアの1例―Parietex^TM Composite Meshの使用経験― Single incision laparoscopic surgery for ventral incisional hernia repair using Parietex^TM Composite Mesh : a case report 吉川祐輔 ¹ , 亀山哲章 ¹ , 冨田眞人 ¹ , 三橋宏章 ¹ , 松本伸明 ¹ , 大渕徹 ¹ Yusuke YOSHIKAWA ¹ , Noriaki KAMEYAMA ¹ , Masato TOMITA ¹ , Hiroaki MITSUHASHI ¹ , Nobuaki MATSUMOTO ¹ , Toru OBUTI ¹ ¹国際親善総合病院外科 ¹Department of Surgery, International Goodwill Hospital キーワード：腹壁瘢痕ヘルニア , 単孔式腹腔鏡下手術 , Parietex^TM Composite Mesh Keyword: 腹壁瘢痕ヘルニア , 単孔式腹腔鏡下手術 , Parietex^TM Composite Mesh pp.323-328

発行日 2012年6月15日 Published Date 2012/6/15

DOI https://doi.org/10.11477/mf.4426100791

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◆要旨：患者は71歳，男性．腹壁瘢痕ヘルニアの嵌頓によるイレウスを繰り返したため手術の方針とした．手術は右下腹部，2.5cmの交叉切開創からグローブ法で単孔式腹腔鏡下手術を施行した．修復にはわが国で2011年4月より保険償還が可能となったParietex^TM Composite Meshを用いた．術後経過は良好であり，現在に至るまで再発を認めていない．単孔式腹腔鏡下手術による腹壁瘢痕ヘルニア修復に関する報告は少ないが，腹壁瘢痕ヘルニアに対する低侵襲手術の選択肢の1つになりうる術式であり，またParietex^TM Composite Meshは腹腔鏡下手術に適したデバイスと考えられた．

　Single incision laparoscopic surgery is a rapidly advancing technique in laparoscopic surgery because of the cosmetic result. The minimally invasive surgery for incisional hernia is appropriate for this technique, although few results have been published so far. We report an incisional hernia repair through a single incision laparoscopic surgery with Parietex^TM Composite Mesh. A 71 year-old man was admitted to the hospital because of repeated ileus through ventral incisional hernia for the past 5 months. The patient had undergone laparoscopic abdominoperitoneal resection for rectal cancer and laparoscopic-assisted distal gastrectomy for gastric cancer 51 months and 49 months ago, respectively. The presence of a defect measuring 5×6 cm was detected and this was considered to be the cause of the repeated ileus. A single incision laparoscopic surgery through the 2.5 cm wound on the right flank was performed. Open technique with Wound retractor^® and a glove was used to reach the abdominal cavity. Pneumoperitoneum was kept at 8 mmHg and a 5mm non flexible scope was used. The hernia edge was made free by using the bipolar forceps. Then Parietex^TM Composite Mesh was inserted in the abdomen and fixed to the abdominal wall by using Absorba tack^TM. Total operative time was 128 minute. Blood loss was insignificant. There was no intraoperative complication. There was no evidence of early recurrence during follow-up periods of three months. In summary, single incision laparoscopic surgery using Parietex^TM Composite Mesh is suitable for laparoscopic incisional hernia repair.