上腰ヘルニアを腹腔鏡下に修復した1例

Tension-free laparoscopic repair of superior lumbar hernia

◆要旨：上腰ヘルニアは症例が少なく，様々な術式で治療されている．本疾患例に対する腹腔鏡下手術を経験した．患者は74歳，男性．左腰背部の鈍痛を伴う膨隆を主訴に来院した．CTでは左腎周囲脂肪が第12肋骨下，腰方形筋外側の腹壁欠損部から広背筋に覆われて背側に突出していた．左上腰ヘルニアと診断して手術を行った．腹腔鏡下に左腎臓を授動すると腹横筋腱膜にヘルニア門が確認でき，ポリプロピレンメッシュで修復した．腹腔鏡下tension-free修復術は直視下修復術と比べて術後疼痛・入院期間・社会復帰までの期間において優位性が示され，再発率も少ない傾向にある．標準術式となりうるか，集積された症例の検討に期待したい．

Superior lumbar hernia is an uncommon clinical defects of the abdominal wall with various repairing techniques published in the literature. Here, we report a case of superior lumbar hernia treated with a laparoscopic approach. A 74-year-old Japanese man, 4 years after open radical prostatectomy, presented with a painful mass on his left back. Computed tomography revealed perirenal fat protruding through the posterolateral abdominal wall just below the left 12th limb, indicating a superior lumbar hernia. Defect in the aponeurosis of the transversalis muscle was confirmed by laparoscopy and polypropylene mesh was placed. Tension-free laparoscopic repair may have advantages over open repair for superior lumbar hernias. Additional case reports and further examination of the short- and long-term surgical results are necessary to establish tension-free laparoscopic surgery as the standard technique for hernia repair.