恥骨上切開による単孔式腹腔鏡下腹膜外アプローチで修復した両側閉鎖孔ヘルニアの2例

Two cases of bilateral obturator hernia repairerd by laparoscope-assisted totally extraperitoneal approach via lower abdominal single incision

◆要旨：閉鎖孔ヘルニア嵌頓に対する非観血的整復後，恥骨上切開からの単孔式腹腔鏡下腹膜外アプローチによる根治術を行い良好な経過を得た2例を経験したので報告する．症例1は89歳，女性．左閉鎖孔ヘルニア嵌頓に対し非観血的整復を行い，待機的根治術を施行した．恥骨上小切開からの単孔式腹膜外アプローチで手術を行った．症例2は87歳，女性．同様に待機的根治術を施行した．全身状態不良のため腰椎麻酔下，吊り上げ法で行った．2例とも対側にも閉鎖孔ヘルニアを認め，同時修復した．恥骨上切開は創直下に閉鎖孔を観察でき，必要最小限の剝離でメッシュを展開できた．腰椎麻酔下にも施行可能で，低侵襲性かつ整容性に優れた方法と考えられた．

We report two cases of incarcerated obturator hernia reduced noninvasively and treated safely by laparoscopic totally extraperitoneal approach via lower abdominal single skin incision. The first case was an 89-year-old woman who was diagnosed as having a left incarcerated obturator hernia by abdominal CT scan. Noninvasive reduction of strangulation improved her symptoms and laparoscopic herniorrhaphy was performed one month later. The hernia was repaired by laparoscopic totally extraperitoneal approach via lower abdominal single small skin incision. Obturator hernia ring was covered by flat mesh. The second case was an 87-year-old woman who was diagnosed as having incarcerated obturator hernia which was reduced noninvasively. She underwent laparoscope-assisted hernia repair. The operation was performed under spinal anesthesia owing to her poor general condition. A good laparoscopic visual field was obtained by abdominal wall lifting method, and obturator foramen was covered by flat mesh. These two patients were diagnosed as having bilateral obturator hernias during operation, and both hernias were repaired simultaneously. They recovered uneventfully with no recurrence. Under laparoscopic view via lower abdominal incision, obturator foramen was observed just below the wound. The mesh could be inserted with minimum preperitoneal dissection. This procedure is a noninvasive method which could be performed under spinal anesthesia with good cosmetic results and it may be useful for obturator hernia repair.