形状記憶ヘルニア用メッシュを用いて腹腔鏡下ヘルニア修復術を行ったスピーゲルヘルニアの1例

A case of spigelian hernia repaired by laparoscopic surgery with Composix Kugel PatchⓇ

◆要旨：患者は68歳の男性で，左下腹部の膨隆と痛みを主訴に受診した．腹部CTと腹部超音波検査で左腹直筋外縁に脱出する腸管を認めた．スピーゲルヘルニアと診断し，腹腔鏡下ヘルニア修復術を行う方針とした．腹膜を切開し，腹膜前腔にメッシュが挿入できるスペースを剝離した．Composix Kugel Patch^®に支持糸として2-0ナイロン糸を付け，腹壁に固定した．腹膜は連続縫合で閉鎖した．術後合併症，再発は認めなかった．形状記憶ヘルニア修復用メッシュを用いる腹腔鏡下ヘルニア修復術は，簡便かつ低侵襲でスピーゲルヘルニアの治療の良い適応である．

A 68-year-old man was referred to our hospital because of a painful palpable mass over his left lower abdomen. Abdominal ultrasonography and CT revealed bowel prolapsing at the lateral edge of rectus abdominal muscle. Based on the preoperative diagnosis of spigelian hernia （SH）, laparoscopic repair of the hernia was performed. The peritoneum surrounding the defect was dissected circumferentially and 2-0 nylon threads were used to fix the Composix Kugel Patch^® to the preperitoneal space. The peritoneal flaps were stitched together with running sutures. The postoperative course was uneventful and the patient was discharged on postoperative day 3. This is the first report of SH repair with Composix Kugel Patch^® by laparoscopic surgery in Japan. Composix Kugel Patch^® includes a shape-memory ring. It facilitates the procedures under laparoscopic surgery and may be useful for laparoscopic SH repair.