再発食道裂孔ヘルニアに対して腹腔鏡下に再手術を施行した1例

A case of laparoscopic reoperation for recurrent hiatal hernia

◆要旨：患者は50歳代，男性．食道裂孔ヘルニアに対して6年前に他院で腹腔鏡下噴門形成術を施行された．術後1年後におくびと食道下部違和感を認めた．上部消化管X線造影検査，上部消化管内視鏡検査，胸部CT検査で食道裂孔ヘルニアの再発と診断し，再手術を施行した．食道裂孔の開大が著明であり，食道裂孔縫縮後にメッシュによる補強を施行し，逆流防止術としてToupet噴門形成術を行った．手術時間は256分で，出血量は少量であった．術後第1病日より経口摂取を開始し，第8病日に軽快退院した．

The patient was a man in his fifties. He underwent laparoscopic fundoplication for esophageal hiatal hernia at another institute six years earlier. He developed belching and discomfort in the lower part of the esophagus approximately one year following surgery. Recurrent esophageal hiatal hernia was diagnosed upon upper gastrointestinal tract X-ray contrast radiography, upper gastrointestinal endoscopy, and chest CT scan, in which the esophageal hiatus was prominent. Therefore, reoperation was performed laparoscopically. Reinforcement using a mesh was carried out after narrowing the esophageal hiatus and Toupet fundoplication was added to prevent gastroesophageal reflux. The operation time was 256 minutes and there was little bleeding. Oral intake began on the first hospital day following surgery and the patient was discharged from the hospital on the eighth hospital day.