S状結腸過長症に対する単孔式腹腔鏡補助下経肛門的S状結腸切除術

Single incision laparoscopy assisted trans-anal sigmoidectomy for sigmoid elongation

◆要旨：S状結腸捻転を繰り返すS状結腸過長症の9歳男児に対し，単孔式腹腔鏡補助下経肛門的S状結腸切除術を施行した．手術は臍内縦切開でEZアクセスを挿入して行った．単孔式腹腔鏡下にS状結腸間膜の処理を行った後，遊離したS状結腸を経肛門的に翻転させ直腸脱を作製した．直腸脱の外筒を切開し，内筒のS状結腸をさらに肛門外に引き出して適切な長さで切除した．肛門外でS状結腸の断端に自動吻合器のアンビルヘッドを装着した後，肛門外に翻転した直腸断端と自動吻合器にて吻合した．創部は臍内に1.5cmと小さく，整容性に優れていた．単孔式腹腔鏡補助下経肛門的S状結腸切除は，S状結腸捻転を繰り返すようなS状結腸過長症に対しては非常に有用であった．

Trans-anal sigmoidectomy under single incision laparoscopy was performed on a 9 years old boy who had sigmoid colon elongation suffering from repeated sigmoid volvulus. Midline incision was made inside the umbilicus for single incision laparoscopy. The vessels of the sigmoid colon were divided under laparoscopy and trans-anal rectal prolapse was made. The rectal wall was incised and sigmoid colon was pulled out more. Resection of the sigmoid colon was performed outside the anal with adequate length. The anvil head of circular stapler was attached to the end of the sigmoid colon and the shaft of circular stapler was attached to the end of the rectum. Anastomosis was done under laparoscopy. After the operation, the patient no longer complained of any symptom. The incision was placed inside the umbilicus and the procedure was effective cosmetically.