回腸導管傍ストーマヘルニアに対して腹腔鏡下Sugarbaker法を施行した1例

A case of laparoscopic Sugarbaker repair of a parastomal hernia which occurred in the urostomy

◆要旨：回腸導管造設後の晩期合併症として発生した傍ストーマヘルニアに対し，腹腔鏡下Sugarbaker法で修復した症例を経験したので報告する．患者は56歳，男性．2007年1月に直腸癌（Rs）の膀胱浸潤に対し，低位前方切除術，膀胱全摘術，回腸導管造設術を施行した．術後2年目よりCTにて傍ストーマヘルニアを認めたが保存的に加療した．2014年6月にストーマ周囲の痛みが出現し，腹腔鏡下Sugarbaker法を施行した．合併症なく術後3病日に退院した．現在，術後8か月再発なく経過中である．回腸導管傍ストーマヘルニアに対する腹腔鏡下Sugarbaker法の報告例は本邦では未だ少ないが，有用な方法であると考えられた．

We report a case of laparoscopic Sugarbaker repair of a parastomal hernia which occurred in the urostomy as a late complication. The patient was a 56-year-old man who had undergone low anterior resection, total cystectomy, and construction of ileal conduit for rectal cancer（Rs） with bladder invasion in January 2007. We detected a parastomal hernia by CT scan in 2009 two years after surgery, but the patient did not want to receive operative treatment. Thus, he was followed-up. In June 2014, he began to complain of a pain around the stoma, and he was treated with laparoscopic Sugarbaker repair of parastomal hernia using Parietex^TM Parastomal Mesh Centerband type（Covidien, Ireland）. He left the hospital at 3days after operation without complications. In a CT scan taken 2months after surgery, the patient exhibits no evidence of hernia recurrence, but an asymptomatic seroma appeared. In a CT scan taken 7months later, the seroma disappeared. Until today, in Japan, there were only a few reported cases about laparoscopic Sugarbaker repair of a parastomal hernia which occurred in the urostomy, but it is suggested that this method is useful.