Bilayer patch法により修復された再発左鼠径ヘルニアの術後遅発性メッシュ感染に対してideal-Hybrid法（腹腔鏡下誘導前方切開法）で手術を施行した1例

Laparoscopy-assisted anterior approach （ideal-hybrid surgery） for late onset mesh infection following recurrent inguinal hernia repair by bilayer patch device

◆要旨：患者は76歳女性で左鼠径ヘルニア再発に対して9年前にbilayer patch法による修復が行われた．2年前から術創より膿汁排出を認め，皮膚瘻形成を伴う再発左鼠径ヘルニア術後遅発性メッシュ感染と診断した．腸管との交通や腹腔内臓器損傷の可能性を考え，臍部にポートを挿入し，腹腔鏡観察下に前方アプローチでメッシュ除去を行った（ideal-Hybrid法）．ヘルニアはMcVay法に準じた修復を行った．合併症なく退院し，現在術後2年経過しているが再発を認めない．遅発性メッシュ感染に対してideal-Hybrid法が行われた報告は自験例のみである．特にanterior space，posterior spaceの両者にメッシュが留置されている場合，腹腔鏡観察が解剖把握の補助となり，その結果合併症率を減少させることができると考えられた．

　A 76-year-old female underwent inguinal hernioplasty for recurrent left inguinal hernia using Prolene Hernia System^Ⓡ （PHS） mesh 9 years ago. She was referred to our hospital with 2 years history of purulent discharge from the surgical site. A thorough examination showed that she had a cutaneous fistula associated with late onset mesh infection. Because of the risk for bowel, peritoneal and vascular injury, and in order to prevent bacterial contamination into the peritoneal cavity during surgery, hybrid surgery to remove the infected mesh was performed. A port was established in the umbilical site, and laparoscopy-assisted anterior approach was performed to remove the infected tissue, fistula and mesh. Then, inguinal hernia was repaired with McVay method. The patient was discharged without any complications, and neither hernia recurrence nor infection has been observed for 15 months. Effectiveness of hybrid surgery for recurrent hernia has recently been reported, however, to the author's knowledge, this is the first report that hybrid surgery was used for the treatment of late onset mesh infection. Especially when mesh was used both in anterior and posterior spaces, we believe that laparoscopic observation helps surgeons to identify anatomical location of the organs, resulting in possible reduction of complication rate.