双孔式S状結腸ストーマに発生した傍ストーマヘルニアに対し腹腔鏡下にmodified Sugarbaker techniqueで修復した1例

Laparoscopic repair of a parastomal hernia which occurred in the double-barreled stoma of the sigmoid colon with a modified Sugarbaker technique

◆要旨：双孔式S状結腸ストーマに発生した傍ストーマヘルニアに対しParietex^TM parastomal mesh（以下，PCOPM）を用いて腹腔鏡下にmodified Sugarbaker techniqueで修復した1例を報告する．患者は52歳，男性．臀部の広範囲感染を伴う痔瘻癌に対し感染制御目的で双孔式S状結腸ストーマ造設術を行った．しかし感染は改善せず化学放射線療法を断念し，感染巣を含む臀部広範囲切除を伴う腹会陰式直腸切断術を行った．術後傍ストーマヘルニアを併発したため腹腔鏡下メッシュ修復術を行った．ヘルニア門は4×7cm，双孔式ストーマの肛門側腸管は約10cm残存していたため，ヘルニア門直下で切離し，洗浄後にヘルニア門中心にPCOPMを腹壁に固定した．術後1年5か月の現在まで合併症や感染は認めていない．

We report a case of laparoscopic repair of a parastomal hernia which occurred in the double-barreled stoma of the sigmoid colon, using Parietex^TM parastomal mesh（PCOPM）, with modified Sugarbaker technique. A 52-year-old man had undergone a double-barreled stoma of the sigmoid colon due to anal fistula cancer, with extensive infection of the buttocks, for the purpose of controlling infection. However, infection did not improve after the operation. Therefore, we abandoned the chemoradiotherapy and performed abdominoperineal resection with an extensive resection of the buttock, including the focus of infection. The patient developed a parastomal hernia after the surgery. We performed laparoscopic repair of parastomal hernia with modified Sugarbaker technique. The hernia orifice was as large as 4×7cm, and about 10cm of the anal side of colon in the double-barreled stoma remained. We separated the anal side residual colon near the hernial orifice. After washing with 1 liter saline, we fixed a PCOPM to the abdominal wall, centering around the hernial orifice. One year and 5 months after the surgery, recurrence of hernia and infection were not observed.