腹腔鏡下修復術を施行したupside down stomachを伴う食道裂孔ヘルニアの1例

A case of laparoscopic mesh repair of esophageal hiatal hernia showing upside down stomach

◆要旨：患者は76歳，女性．8年前より食道裂孔ヘルニアを指摘され他院で手術を勧められていた．今回，嘔吐が出現したため当科を紹介され受診した．CTおよび上下部消化管透視検査で，縦隔内に全胃および横行結腸が脱出していることが確認された．胃は軸捻転を伴い，upside down stomachを呈する食道裂孔ヘルニアと診断し，腹腔鏡下手術を施行した．縦隔内に脱出した臓器を還納し，食道裂孔部を縫縮した後，composite meshで補強し，Toupet噴門形成術を追加した．術後再発なく経過しており，本疾患に対するメッシュを用いた腹腔鏡下手術は有用であると考えられた．

　A 76-year-old woman with eight years history of esophageal hiatal hernia was admitted to our hospital because of vomiting. Computed tomography and fluoroscopy demonstrated herniation of both stomach and transverse colon into the mediastinum. Esophageal hiatal hernia showing upside down stomach and mesenterioaxial volvulus were diagnosed, and laparoscopic surgery was performed. Herniated stomach and transverse colon were reduced and the large hiatal defect （6cm） was closed by primary suture. Suturing repair was reinforced with composite mesh and Toupet fundoplication was added. Postoperative course was uneventful and there was no postoperative relapse. Laparoscopic surgery using mesh for esophageal hiatal hernia with upside down stomach was useful and safe.