鼠径ヘルニア術後の慢性疼痛に対して腹腔鏡下メッシュ除去が著効した1例

Chronic postoperative pain following inguinal hernia repair that improved by laparoscopic resection of the mesh

◆要旨：患者は39歳，女性．左鼠径部の疼痛を主訴に当院を受診した．27歳時に左鼠径ヘルニアの診断でBard^Ⓡ Kugel^Ⓡ Patchを用いた鼠径ヘルニア修復術の既往があった．鼠径ヘルニア術後慢性疼痛と診断し，腹腔鏡下異物除去およびヘルニア修復術を施行した．手術所見は，左腹壁より腹腔内に突出したメッシュを認め，メッシュは腹膜前腔で十分に広がらず屈曲していた．症状の原因と考え，メッシュを除去する方針とした．メッシュは周囲組織に強固に癒着しており，メッシュすべての摘除は困難と考え，症状の原因と考えられた突出部分のみの摘除を行った．補強が不十分な箇所にメッシュを留置し，手術を終了した．術後，左鼠径部の違和感と疼痛は軽快した．

Chronic postoperative pain following inguinal hernia repair has been defined as pain that develops after the operation and lasts for at least 6 months. Recently, we experienced a case of a 39-year-old woman who had undergone open hernia surgery 12 years previously. She complained of left inguinal pain that appeared several years previously. She had no Tinel sign or burning sensation. However, movement of the hip joint worsened her pain. Computed tomography showed that the mesh had not unfolded completely and the hernia had not relapsed. We strongly suspected that her chronic pain was associated with inguinal hernia repair. She requested surgical treatment, and laparoscopic surgery was performed for removal of the mesh from the operation site. During surgery, we noted that the mesh was protruding into the peritoneal cavity and was attached to surrounding tissues. Therefore, it was difficult to remove the entire mesh. The area with the mesh was partially resected and the untreated area was repaired to prevent recurrence. Her inguinal pain disappeared immediately after the surgery. It is important to assess postoperative pain and examine whether tissue or nerve injury is present. We believe that the laparoscopic approach is useful for mesh removal and recognizing anatomical positions.