閉鎖孔ヘルニアに対する腹腔鏡補助下鼠径法による修復術

Laparoscopic assisted inguinal approach method for obturator hernia repair

◆要旨：閉鎖孔ヘルニアは未だ術式が定型化していない．今回，従来の鼠径法に腹腔鏡の補助を試み有用な手法と考えたので報告する．鼠径法で腹膜前腔にアプローチし閉鎖孔に到達する．嵌頓腸管を含むヘルニア囊をHutchinson手技に倣って嵌頓を解除する．解除後にヘルニア囊を開放しポートを挿入し気腹する．内視鏡を挿入し腸管の色調と対側の閉鎖孔を内視鏡下に確認する．腸管の色調が不良な場合はポートを抜去し，開放したヘルニア囊より腸管を順次腹腔外へ引き出し腸管切除と吻合も可能である．腸管を骨盤腔内に還納後ヘルニア囊を縫合閉鎖しメッシュを閉鎖孔から大腿輪まで覆うように腹膜前腔内に留置する．上記手法は低侵襲かつ容易でありその手技を報告する．

Surgery for obturator hernia repair has not yet been standardized. We report that the inguinal approach with laparoscopic assistance is a useful technique. The approach to the obturator foramen is via the extraperitoneal space using the inguinal method. The hernia sac containing the bowel is released using the Hutchinson procedure. After release, the hernia sac is opened and a camera port is inserted into it and carbon dioxide gas is insufflated into the peritoneal cavity. A laparoscope is then used to check the obturator foramen on the opposite side of the hernia and also to check the color of the released bowel. If the color of the bowel is unreassuring, the port is removed, the bowel is sequentially exposed and a resection and anastomosis can be performed . After the bowel is returned into the pelvic cavity, the opened hernia sac is sutured closed and a mesh sheet is securely placed in the extraperitoneal cavity so as to cover the obturator foramen and the femoral ring. The above approach is a straightforward and minimally invasive surgical technique.