腹腔鏡下鼠径ヘルニア修復術（TAPP法）総手術時間からみた高難度症例の検討

Surgical outcome of laparoscopic inguinal hernia repair performed by a single surgeon and an evaluation of difficult cases

◆要旨：腹腔鏡下鼠径ヘルニア修復術（TAPP法）を初発鼠径部ヘルニアに導入して121症例/130病変を経験した．単一術者が行った連続100症例/105病変の総手術時間を各因子別に解析した．総手術時間は平均87.9±22.2分であった．男性症例で手術時間が有意に延長したが，左右別と日本ヘルニア学会（JHS）分類別では手術時間に有意差を認めなかった．導入初期20例を除いて総手術時間が平均値より30％以上延長した症例につき検討した．手術時間延長症例は全例JHS I型男性症例でヘルニア囊が陰囊内に至る症例，または左側でS状結腸がヘルニア囊に癒着している症例であった．術後合併症は認めず，術後再発も発生していない．TAPP法は安全に導入されていた．

［Background］We started to perform laparoscopic transabdominal preperitoneal repair（TAPP） for an initial groin hernia from April 2012. We have so far experienced 121 cases（130 lesions）. ［Objective and Method］ We analyzed the surgical outcomes of all cases, and the results of the total operation time of 100 consecutive cases（105 lesions） that were repaired by TAPP procedures performed by a single surgeon. ［Results］ The total operative time of 100 consecutive patients performed by a single surgeon was 87.9±22.2 minutes. The operative time was significantly prolonged in male cases, however, there was no significant difference regarding either the location or the JHS category. We examined cases in which the total operative time was prolonged by 30％ or more from the average, while excluding 20 cases at the initial stage of introduction. The cases with an extended operative time were seen in JHS I type hernia and scrotal hernia, especially in a case of sigmoid colon adhesion to the hernia sac. No postoperative complications corresponding to the Clavien-Dindo classification and no cases of recurrence were encountered. ［Conclusion］ At our institute, laparoscopic herniarrhaphy（TAPP） for the repair of an initial inguinal hernia was performed safely and effectively.