食道癌術後に発生した食道裂孔ヘルニアに対して腹腔鏡下に修復しえた1例

Laparoscopic hernia repair for hiatal hernia after esophagectomy : A case report

◆要旨：患者は81歳，男性．約2年前に他院で早期食道癌に対して内視鏡下食道亜全摘術を施行された．昼食後から左上腹部痛が出現し，当院に救急搬送された．CTで小腸と横行結腸が左胸腔内に脱出していた．食道裂孔ヘルニアと判断し緊急手術を行った．手術は腹腔鏡下に行った．挙上胃管左側と左横隔膜脚の間に食道裂孔ヘルニアを認めた．脱出腸管を腹腔内に還納したところ脱出腸管に血流障害は認めなかった．左横隔膜脚と胃管を結紮縫合することでヘルニア門を閉鎖した．経過は良好で術後4日目に退院となった．術後8か月経過し再発は認めていない．

An 81-year-old man with early esophageal cancer underwent video-assisted thoracic surgery of the esophagus and posterior mediastinal reconstruction of a gastric tube. Two years after the surgery, the patient complained of left upper abdominal pain. Computed tomography showed the small intestine and transverse colon in the left thoracic cavity, and thus, a hiatal hernia was diagnosed. We performed laparoscopic repair ; the incarcerated bowel showed no findings of necrosis and was reduced to the abdominal cavity. The diaphragmatic defect was closed by suturing the gastric tube and the left crus of the diaphragm with unabsorbable sutures. The patient recovered well and was discharged four days after surgery. No recurrence has been observed during the eight months of postoperative follow-up.