腹壁瘢痕ヘルニア併存-傍ストーマヘルニアに対して腹腔鏡下根治術（Sandwich法）を施行した1例

Simultaneous repair of concomitant parastomal and incisional hernias by the laparoscopic Sandwich technique : A case report

◆要旨：患者は71歳，男性．69歳時にS状結腸癌の穿孔による汎発性腹膜炎に対してHartmann手術を受け，S状結腸人工肛門を造設された．正中創部と人工肛門周囲の膨隆を主訴に来院し，腹部CTで傍ストーマヘルニアと腹部正中切開部の腹壁瘢痕ヘルニアと診断された．後日入院し手術を行った．腹腔鏡下に1枚のメッシュにて両ヘルニアに対しKeyhole法を行い，傍ストーマヘルニアにSugarbaker法を加えたSandwich法にて同時に修復した．術後正中創周囲の発赤，疼痛が出現したが軽快し11日目に退院した．術後14か月経過したが再発を認めていない．

　A 71-year-old man who underwent Hartmann's operation for panperitonitis due to a perforated sigmoid colon cancer two years previously, presented with complaints of bulges in the midline scar and around the stoma. Computed tomography scan showed a parastomal hernia and an incisional hernia. He was admitted and underwent repair using the laparoscopic sandwich technique. The first procedure was a laparoscopic keyhole operation using a single piece of mesh to repair both hernias simultaneously. The second procedure applied the Sugarbaker technique to the parastomal hernia. Although there was transient inflammation and pain, the patient was discharged 11 days after surgery. He remains asymptomatic 14months after repair.