鮒田式胃壁固定具ⅡTMを用いた腹腔鏡下腹壁瘢痕ヘルニア修復術の工夫

Mesh fixation using the Funada-Style Gastropexy DeviceⅡ for laparoscopic incisional hernia repair

◆要旨：腹腔鏡下腹壁瘢痕ヘルニア修復術における鮒田式胃壁固定具Ⅱ^TMを使用したメッシュ固定の工夫について報告する．メッシュを腹腔内に挿入し仮固定した後に，カテラン針を用い，試験穿刺を行い，運針の方向を決定する．その後，鮒田式胃壁固定具Ⅱ^TMを用いて2-0ナイロンを皮下，腹壁，メッシュ，腹壁，皮下と貫通させ，モスキートを用い，皮下を通して一方の糸を同側に引き出し，皮下にて結紮縫合する．8〜12針縫合固定した後，吸収性タッカーにてメッシュを固定し，double Crown法を施行する．本法は，意図的な運針と簡便かつ確実なメッシュの固定が可能で有用な方法と考えられた．

We report a novel mesh fixation technique using the Funada-style Gastropexy DeviceⅡ （FGⅡ, Create Medic Co., Ltd） for laparoscopic incisional hernia repair. After inserting and spreading out the mesh, we attached the mesh temporarily. First, we decided the direction of handling for the FGⅡ using a Cattelan needle with a test puncture. Next we used a 2-0 nylon suture to sequentially penetrate the subcutaneous tissue, abdominal wall, mesh, abdominal wall, and subcutaneous tissue using the FGⅡ. Using a mosquito clamp, we could extract one thread in the same region of another thread, and the threads were then tied in the subcutaneous layer. We performed the double crown technique for mesh fixation, and added absorbent tacks among the threads after 8-12 sutures with the FGⅡ. Mesh fixation using the FGⅡ for laparoscopic incisional hernia repair was safe and technically feasible, it ensured puncture of the intended target, and was a convenient technique for this procedure.