腹腔鏡下腹壁瘢痕ヘルニア修復術後のメッシュ感染に対し陰圧閉鎖療法にてメッシュを除去せず完治しえた1例

A case of mesh infection following laparoscopic ventral hernia repair using negative pressure wound therapy

◆要旨：患者は76歳，男性．下腹部正中切開創部からの腹壁瘢痕ヘルニアに対し，腹腔鏡下手術を施行した．3か月後に救急外来を受診し，元のヘルニア囊部に熱感を伴う軟性の腹壁の膨隆を認め，CT上はメッシュ腹側に少量の気泡を伴う膿瘍形成を認めた．診察中に意識低下・ショックとなりメッシュ感染・敗血症の診断で緊急手術を施行した．ヘルニア再発や腸管の脱出・穿孔を疑う所見はなく，メッシュ除去は行わずに切開排膿ドレナージのみとした．敗血症に対する治療を行いつつ術後9日目から陰圧閉鎖療法を開始した．陰圧閉鎖療法のフィラーの交換を繰り返し行い，感染の再発なく経過し，術後30日目に退院となった．その後ヘルニアの再発も認めなかった．

　The patient was a 76-year-old male who had undergone laparoscopic ventral hernia repair for a hernia stemming from a lower-mid incision. Three months later, he visited the emergency ward of our hospital because of high fever and abdominal wall swelling. Computed tomography findings revealed an abscess formation, including free air just above the mesh. He suffered severe drop in blood pressure during these examinations. Thus, a diagnosis of severe sepsis due to mesh infection was made, and an emergency surgery was performed. We performed incisional drainage of the abscess without removing the mesh because there was no hernia recurrence and no perforation or injury of the intestine. After the treatment for septic shock, negative pressure wound therapy （NPWT） was initiated on postoperative day 9. We replaced the NPWT device repeatedly, and the wound gradually shrank without recurrence of the infection. The patient left our hospital on postoperative day 30 and there has been no recurrence of ventral hernia.