IPOM Plus法による腹腔鏡下手術を施行したSpigelヘルニアの1例

Laparoscopic repair for Spigelian hernia : A case report

◆要旨：患者は73歳，男性．右鼠径ヘルニアの手術歴があるが，他に特記すべき既往はなかった．左下腹部の膨隆・違和感を主訴に当院を受診した．腹部CT検査で左腹直筋外縁に小腸の脱出を認め，Spigelヘルニアと診断し，腹腔鏡下腹壁ヘルニア修復術（intraperitoneal onlay mesh : IPOM法）にヘルニア門縫合を加えたIPOM Plus法を施行した．手術は3ポートを留置し，ヘルニア囊周囲の癒着を剝離した．ヘルニア門を計測した後，ヘルニア門を縫合閉鎖した．Ventralight ST^TMメッシュを挿入し，ダブルクラウン法にて固定した．術後経過は良好で，第7病日に退院となった．Spigelヘルニアは腹壁ヘルニアの約2％と稀な疾患である．腹腔鏡下，特にIPOM Plus法での手術報告は少なく，若干の文献的考察を含めて報告する．

　A 73-year-old man presented with left lower abdominal mass with discomfort. It had started as a small bulge about 3 years ago, but it gradually increased in size. Abdominal computed tomography showed the absence of muscular fasciae and protrusion of small intestine at the left lateral margin of the rectus abdominis muscle. Preoperative diagnosis of Spigelian hernia was made, and we performed laparoscopic intraperitoneal onlay mesh repair with closure of hernia orifice （IPOM Plus）. We identified a round hernia orifice, approximately 3 cm in size, in the lower quadrant. The hernia orifice was covered with Ventralight^TM mesh. The patient was discharged 7 days after surgery with no perioperative complications. Spigelian hernia represents about 2% of all abdominal wall hernias. Few cases of IPOM Plus for Spigelian hernia have been reported. We report this case with literature review.