TAPP法にて修復した鼠径部半月状線ヘルニアの1例

A case of Spigelian hernia developing on the groin repaired by transabdominal preperitoneal approach

◆要旨：TAPP法にて修復した鼠径部半月状線ヘルニアの1例を経験した．患者は91歳の女性で，左鼠径ヘルニア嵌頓が疑われ当院に搬送された．左鼠径部に膨隆を認めたが用手還納は可能であり，腹部CTにて腸管の脱出を伴う左鼠径ヘルニアと診断された．翌日，待機的に腹腔鏡下ヘルニア修復術を施行した．術中当初は併存型鼠径ヘルニアと判断し，腹膜前修復法（TAPP法）に準じて腹膜前腔の剝離を進めると，実際のヘルニア門は内鼠経輪の頭側かつ腹直筋外側の腹横筋腱膜弓下に存在した．ヘルニア門と近傍のmyopectineal orifice（MPO）を覆う範囲にメッシュを留置した．術後経過は良好で，現在まで再発は認めていない．

　We experienced a case of Spigelian hernia developing on the groin repaired by transabdominal preperitoneal repair （TAPP）. A 91-year-old woman was admitted to our hospital with suspected left inguinal hernia incarceration. Although bulging was recognized in the left inguinal region, it was reduced easily by hand. The left inguinal hernia with intestinal incarceration was diagnosed by abdominal CT scan. Laparoscopic hernia repair was performed the next day. The operation revealed the actual hernia orifice to be located at the cranial side of the inner inguinal ring and more outside to the rectus abdominis. A mesh was placed in a range covering Spigelian hernia orifice and neighbouring myopectineal orifice （MPO）. The postoperative course was uneventful, and so far, there has been no recurrence.