TAPP法で腹腔鏡下に同時修復を行った外鼠径，大腿，膀胱嵌頓閉鎖孔ヘルニアを合併した1例

A case of one-stage laparoscopic repair for inguinal, femoral and incarcerated obturator hernias using transabdominal preperitoneal approach

◆要旨：患者は88歳の女性．数か月前からの右鼠径部膨隆を主訴に近医より紹介となった．理学所見で右鼠径ヘルニアと診断したが，CTで膀胱嵌頓の右閉鎖孔ヘルニアも指摘された．頻尿と残尿感を自覚しており腹腔鏡下にtransabdominal preperitoneal approach（以下，TAPP法）で同時修復を行う方針とした．腹腔内より観察したところ上記ヘルニアに加えて，大腿輪も開大しており，これら3種ヘルニアに対し，メッシュを2枚用いて一期的に修復した．上記3種ヘルニアに対するTAPP法を用いた一期的腹腔鏡下修復術の報告は少なく，有用であったので報告する．

A 88-year-old female, presented with a right inguinal bulge, and was initially diagnosed with inguinal hernia. At the same time, the patient had urinary symptoms such as sensation of residual urine and pollakisuria. On further work-up, computed tomography showed right incarcerated obturator hernia of the urinary bladder. The patient underwent laparoscopic hernia repair using transabdominal preperitoneal approach （TAPP）. Intraoperatively, a femoral hernia was also identified. Hernia repair using mesh application was used for the surgery, which covered the 3 defects. Patient recovery was unremarkable. TAPP was safe and feasible for repairing three hernias, simultaneously.