術後アンケート調査における腹腔鏡下鼠径ヘルニア修復術（TEP）の長期成績と合併症症例の検討

Long-term outcome and complications of laparoscopic total extraperitoneal repair（TEP） for inguinal hernia repair : A questionnaire survey

◆要旨：今回，鼠径ヘルニアに対しlaparoscopic total extraperitoneal repair（TEP）を施行した患者へ，術後アンケート調査を行い，単独施設におけるTEPの長期成績と，合併症症例の検討を行った．再発は5例で，再発率は0.92％（5/541病変）であった．術後平均10.8か月で再発し，5例中2例は他院で外科治療を受けていた．その他に，漿液腫13例（2.4％），表層SSI 1例（0.18％）があり，慢性疼痛を41人（9.1％）に認めた．再発5例のうち3例は，初回で両側病変を手術し，片側が再発していた．再発はすべて外鼠径ヘルニアで，当院で再手術を受けた3例はすべて外側のメッシュ伸展不良が原因であった．TEPでは，初回で両側病変を手術する際に，特に外鼠径ヘルニア症例に関しては，外側の十分な剝離とメッシュ展開に留意する必要がある．

A single-center questionnaire survey was conducted on patients who had undergone laparoscopic total extraperitoneal repair（hereinafter referred to as TEP） of inguinal hernias to evaluate the long-term results and complications of TEP. Five patients had recurrent hernias ; the recurrence rate was 0.92％（5 of 541 hernias） and the mean time until recurrence was 10.8 months. Two of the 5 patients had received surgical treatment for the recurrences in other hospitals. Other complications of TEP included seroma in 13 patients（2.4％）, superficial incisional surgical site infection in 1（0.18％） and chronic pain in 41（9.1％）. Three of the 5 patients had unilateral recurrences after primary bilateral TEP. All 5 patients had recurrent indirect inguinal hernias, 3 of whom were all treated by further surgery in our hospital for the recurrences attributed to inadequate lateral extension of the mesh. The primary bilateral TEP necessitates more attention to adequate lateral dissection and unfolding of the mesh, particularly in patients with indirect inguinal hernias.