経腹的および腹膜外腔アプローチ併用による腹腔鏡下手術を行った閉鎖孔ヘルニアの1例

Obturator hernia repair performed by laparoscopic hernia repair with a combination of transperitoneal and extraperitoneal approaches : a case report

◆要旨：閉鎖孔ヘルニアは，高齢のやせた女性に多いといわれ，以前は術前診断が困難で緊急開腹手術となることが多かった．患者は91歳，女性．右大腿部痛を訴え受診した．腹部・骨盤CTにて右閉鎖孔ヘルニア嵌頓と診断された．右下肢の他動的屈伸運動により閉鎖孔ヘルニアは整復されたため，待機的に経腹的および腹膜外腔アプローチ併用による腹腔鏡下へルニア手術を行った．術後経過は良好であった．経腹的および腹膜外腔アプローチ併用による腹腔鏡下手術を行った閉鎖孔ヘルニアの1例を経験したので報告する．

　An elderly, thin woman may be more likely to have an obturator hernia, and given the difficulty of preoperative diagnosis, emergency laparotomy is frequently performed. A 91-year-old woman who complained of right thigh region pain was admitted to our surgical department. Right incarcerated obturator hernia was diagnosed with abdominal and pelvic CT. Because passive bending and stretching exercises reduced the obturator hernia in the right lower leg, laparoscopic hernia repair was selectively performed with a combination of transabdominal and extraperitoneal approaches. The postoperative course was uneventful. Here, we report a patient with obturator hernia in which laparoscopic repair was performed with a combination of transabdominal and extraperitoneal approaches.