TAPP術後に吸収性有棘連続縫合糸により小腸イレウスを呈した1例

Small bowel obstruction after TAPP caused by barbed suture : Report of a case

◆要旨：Transabdominal preperitoneal repair（TAPP）術後に，腹膜閉鎖に用いた吸収性有棘連続縫合糸（V-Loc^TM）が原因となった癒着性イレウスを経験したので報告する．患者は78歳，男性．両側鼠径ヘルニアに対してTAPP術を施行したが，術後早期より腹痛・嘔吐を訴えイレウス所見を呈し再手術となった．有棘縫合糸断端が原因となって左腹膜閉鎖部に小腸が癒着していた．腹腔鏡下に余剰端を切除し，腸管切除は施行せず，癒着解除のみで手術を終了した．TAPP術の際に，使用されるデバイスの特性によっては予期せぬ合併症をきたす危険性があり注意が必要である.

We hereby report a case of small bowel obstruction, a complication from transabdominal preperitoneal repair（TAPP）, caused by absorbable self-anchoring barbed suture device. A 78-year-old man with symptomatic bilateral inguinal hernia underwent laparoscopic TAPP at our institution. He complained of abdominal pain and vomiting after the operation, and abdominal CT scan showed dilation of the small bowel caused by adhesive obstruction. We performed laparoscopic reoperation for bowel obstruction on the 4th post operative day. Intraoperative findings revealed that the ileum had adhered to the left peritoneal closure site of the first operation. Furthermore, the cut end of the barbed suturing device proved to be the main cause of intestinal adhesion and obstruction. The small bowel obstruction was released by cutting the edge of the string without resecting the intestine. After the operation, the patient was discharged without recurrence of bowel obstruction.