TAPP術後早期に発症した腹膜縫合部離開による小腸嵌頓に対して腹腔鏡下手術を施行した1例

Laparoscopic surgery for small bowel obstruction caused by dehiscence of peritoneal suture site after TAPP : A case report

◆要旨：患者は69歳，男性．両側内鼠径ヘルニアに対してTAPPを施行したが，第2病日に腸閉塞を発症した．保存的治療に抵抗性であり，第6病日に腹腔鏡下手術を施行した．腹腔鏡観察では腹膜縫合部が離開し，同部位に小腸が嵌頓していたため，嵌頓小腸を整復して腸閉塞を解除し，離開した腹膜は再度縫合し，癒着防止シートを貼付して手術を終了した．TAPPを施行するにあたっては，術後腸閉塞を惹起させないための予防策を講じた手術手技を行うことが重要と考えられた．

A 69-year-old male underwent transabdominal preperitoneal repair（TAPP） for bilateral inguinal hernia, and small bowel obstruction developed on postoperative day（POD）2. There was no response to conservative treatment, and laparoscopic surgery was performed on POD 6. Intraoperative findings showed wound dehiscence on the peritoneum and incarceration of the small bowel in the same location. The obstruction was relieved by repairing the incarceration, resuturing the open wound in the peritoneum, and fixing a barrier to prevent adhesion. We believe that it is important to take appropriate measures in order to prevent small bowel obstruction after TAPP.