腹腔鏡操作を伴う内視鏡下腹膜外到達法（hybrid TEP）により治療した閉鎖孔ヘルニア小腸嵌頓の1例

A case of incarcerated obturator hernia operated by laparoscopic-assisted totally extraperitoneal repair（hybrid TEP）

◆要旨：患者は86歳，女性．左閉鎖孔ヘルニア小腸嵌頓の診断で緊急手術となった．臍部にカメラポートを留置し，臍下に2ポートを追加して腹腔鏡下に嵌頓を解除した．続いて内視鏡下腹膜外到達法（totally extraperitoneal repair：TEP）でヘルニア囊周囲を剝離し，メッシュを留置した．再度腹腔内を観察すると，小腸の色調が改善しないため，臍を2cm縦切開して体外で切除吻合した．術後は順調に回復し，11日目に退院した．腹腔鏡操作を伴う内視鏡下腹膜外到達法（hybrid TEP）は腹腔と腹膜前腔の分離が容易で，ヘルニア門修復に人工物を使用しやすい．また視野良好で，十分なサイズのメッシュが留置でき，閉鎖孔ヘルニア嵌頓に有効な術式であると考えられた．

A 86-year-old female diagnosed with a left incarcerated obturator hernia required an emergency operation. Firstly, the incarceration was released laparoscopically using 3 ports. Secondly, the mesh was placed around the hernia orifice using totally extraperitoneal repair（TEP） method．Finally, the incarcerated small intestine was removed and reconstructed through the small navel laparotomy. The postoperative course was favorable, and patient was discharged 11 days after surgery. This method could reduce mesh-related infection because intraperitoneal and extraperitoneal cavities are divided and enabled the placement of an adequate size mesh because TEP provided good view around the hernia orifice. Laparoscopic-assisted totally extraperitoneal repair（hybrid TEP） was useful for incarcerated obturator hernia.