細径把持鉗子を利活用した腹腔鏡下スリーブ状胃切除術の実践

Laparoscopic sleeve gastrectomy with efficient use of a thin grasping forceps

◆要旨：近年，肥満人口が世界的に増加傾向にあるなか，内科的治療に抵抗性の病的肥満症例に対する肥満外科手術が注目を集めている．本邦でも2014年4月から腹腔鏡下スリーブ状胃切除術が保険収載され，今後，本術式の実施例がますます増加するものと思われる．当科では本術式の実施にあたり，細径把持鉗子（3.5mm）を用いた肝挙上を行い，術中視野の確保に努めている．27例に対して本法による手術を実施しているが，重篤な合併症なく，簡便な操作により安全かつ効率的に肝挙上が可能となることから本法は有用と思われる．

Bariatric surgery for morbidly obese patients is one of the most important procedures because the morbidly overweight population is increasing today in the world. Moreover, laparoscopic sleeve gastrectomy has been adapted into medical insurance from April 2014 in Japan. Therefore, this operation will be performed more frequently in patients with morbid obesity in Japan. We try to keep a sufficient surgical field by retracting the liver with a thin grasping forceps（3.5mm） during the operation around the esophagogastric junction and gastric fundus. We have operated on 27 obese patients with this method, and experienced no mortal complications. Our results demonstrated that this method was useful because of its simplicity, safety and efficiency.