腰部肋間斜切開創の腹壁瘢痕ヘルニアに対して腹腔鏡下に修復した1例

Laparoscopic repair of abdominal incisional hernia in a lumbar intercostal oblique incision : A case report

◆要旨：患者は80代，女性．3年前に腎細胞癌に対して肋間斜切開下に左腎部分切除術を施行した．左側腹部の膨隆を主訴に当科を受診し，腹壁瘢痕ヘルニアと診断され，腹腔鏡下腹壁瘢痕ヘルニア修復術を行った．右側臥位で腹腔内を観察すると，第10肋間に径4×8cmのヘルニア門を認めた．10×15cmのメッシュを展開し，肋骨と肋骨下縁の脈管を避けて全層固定・タッキングを行い，メッシュを固定した．3か月後，腹腔鏡下大腿ヘルニア修復術時の腹腔内観察でメッシュ逸脱や離開がないことが確認された．腰部肋間斜切開創に形成された腹壁瘢痕ヘルニアに対して手技を工夫することにより腹腔鏡下で安全確実な修復が可能であった．

　A woman in her eighties consulted us, complaining of swollen left abdomen. Three years prior, she had undergone left partial nephrectomy through intercostal oblique incision for renal cell carcinoma. The diagnosis was abdominal incisional hernia. She underwent laparoscopic incisional hernia repair. Observation of the abdominal cavity in the right lateral position revealed the hernia orifice, with a diameter of 4 × 8 cm in the tenth intercostal space. A mesh measuring 10 × 15 cm was placed above the hernia orifice and was fixed via transabdominal suture and tacking. Care was taken to avoid the rib and its lower edge. Three months later, laparoscopic femoral hernia repair was performed and during the procedure, neither mesh deviation nor diastasis was confirmed. We consider laparoscopic repair of abdominal incisional hernia via a lumbar intercostal oblique incision, as described above, is safe and feasible.