Modified scroll techniqueを用いた腹腔鏡下腹壁瘢痕ヘルニア修復術

The modified scroll technique for mesh placement during laparoscopic ventral hernia repair

◆要旨：腹腔鏡下腹壁瘢痕ヘルニア修復術において，腹腔内でメッシュを展開，固定する方法として，modified scroll techniqueを行っているので報告する．メッシュを両側から中心に向かって丸め中央部を糸で縛る．メッシュを腹腔内に誘導し，両端から巻き込んで隙間となった正中部をタッキングで固定する．その後，メッシュを左右に展開し，メッシュの辺縁を固定する．これまで，5例に対し同方法によるメッシュの固定法を行った．平均手術時間は151.8分，使用メッシュの平均長径は22.4cmであった．全例で完遂可能であり，周術期の合併症はなかった．術後観察期間の中央値は8か月で，再発，慢性疼痛などの合併症は認めていない．

We herein present the modified scroll technique for mesh placement during laparoscopic ventral hernia repair. Surgical technique is as follows. The mesh is rolled from each side to the middle, and a temporary stay suture is placed at the middle of the rolled mesh. The mesh is inserted through the trocar into the peritoneal cavity and lifted towards the abdominal wall by the assistant's forceps. Next, the absorbable tacks are placed along the midline of the mesh to fix the mesh to the abdominal wall. Then the stay suture is cut, and the mesh is widened by right and left. The border of the mesh is fixed by the absorbable tacks. A total of five patients underwent laparoscopic ventral hernia repair using this modified scroll technique. The mean operative time was 151.8 minutes and the mean size of the mesh was 22.4cm. There were no morbidity and mortality during the perioperative period. During a median follow up period of 8 months, there were neither recurrences nor chronic pain. The modified scroll technique for mesh placement during laparoscopic ventral hernia repair is simple and feasible with a low recurrence rate and low complications.