腹腔鏡下ヘルニア修復術の腹膜閉鎖に用いたBarbed Suture（有棘縫合糸）が術後癒着性イレウスをきたした1例

A case of postoperative small bowel obstruction caused by the barbed suture used in laparoscopic inguinal hernia repair

◆要旨：患者は51歳，男性．左鼠径ヘルニアに対し，腹腔鏡下ヘルニア修復術を施行した．術後第3病日に退院となったが，第4病日にイレウス所見を認め再入院となった．保存的加療を行ったが症状は改善せず，第12病日に原因検索のため審査腹腔鏡を施行した．腹膜閉鎖部への小腸の癒着を認め，癒着性イレウスと診断した．癒着部を剝離すると，腹膜より逸脱したV-Loc^TMを認めた．腹腔内に露出し，小腸間膜に癒着したV-Loc^TMを除去し手術終了とした．術後経過良好でイレウス再燃は認めていない．初回手術の際に腹膜閉鎖に用いたBarbed Sutureが原因と考える癒着性イレウスの1例を経験したので，若干の文献的考察を加え報告する．

　A otherwise healthy 51 year-old male underwent laparoscopic hernia repair for left inguinal hernia in our institute and was discharged on postoperative day 3. The patient presented with small bowel obstruction and was re-hospitalized on POD#4. The obstruction was not resolved with conservational management, and the patient was taken to the operating room for exploratory laparoscopy on POD#12. The laparoscopy revealed that the barbed suture, used for the peritoneum closure in the hernia repair, was exposed into the peritoneal cavity which caused the bowel stricture by forming a dense adhesion on the mesentery. The adhesiolysis was performed by extracting the suture laparoscopically. The patient recovered uneventfully and is doing well to date. We report our experience and discuss the clinical course with literature review.