単孔式腹腔鏡下にメッシュを用いて修復したMorgagni孔ヘルニアの1例

A case of single-incision laparoscopic mesh repair of Morgagni hernia

◆要旨：患者は75歳，女性．整形外科術前の胸部X線で右下肺野に異常を指摘され，CTでMorgagni孔ヘルニアと診断された．EZトロッカー2本とEZリンクを刺入したEZアクセスを臍に装着し単孔式腹腔鏡下にSymbotex^TM composite meshを用いて修復した．ヘルニア囊は切除しなかった．メッシュ固定にはEND UNIVERSAL Hernia Staplerを用い，結紮縫合を追加した．単孔式ではステイプラーの挿入位置がより尾側になるため操作性は良好であった．術後経過は良好で，術後5日目に退院し，以後再発を認めていない．Morgagni孔ヘルニアに対する本術式は手技やデバイスの工夫により低侵襲かつ安全，簡便に施行可能と考えられた．

　We report our experience with a single-incision laparoscopic repair for Morgagni hernia, a rare type of the diaphragmatic hernia. A 75-year-old woman was referred to our department for an abnormal mass in the right lower lung area, pointed out on a preoperative screening chest X-ray film prior to orthopedic surgery. The diagnosis of Morgagni hernia was made on computed tomography. EZ access was inserted from the umbilicus, equipped with two EZ trocars and a EZ link. Laparoscopy showed that the hernia content was the greater omentum, which was easily reduced into the abdominal cavity. Hernia hilum was 25×15 mm in size. We applied a 12 cm Symbotex^TM composite mesh for repair. The mesh was fixed to the diaphragm with END UNIVERSAL 65°Hernia Stapler, without a hernia sac resection. We put 3 stitches for reinforcement. Because the mesh was semi-translucent, certainty of the hernia repair was easily confirmed. Flexibility of the stapler made stapling easy even under a single-incision approach. The postoperative course was uneventful. She was discharged on the 5th postoperative day. No sign of recurrence have seen to date. There has been an increase in the number of reports on laparoscopic repair for Morgagni hernia, most of them were multi-incision laparoscopic surgery. We conclude that single-incision laparoscopic repair is an applicable procedure for treatment of the Morgagni hernia.