腹腔鏡下鼠径部ヘルニア修復術（TAPP）後の慢性疼痛に対して腹腔鏡下メッシュ除去術にて改善を認めた1例

A case of chronic pain after transabdominal preperitoneal approach（TAPP） which improved after laparoscopic mesh removal

◆要旨：患者は64歳，男性．1年前からの左鼠径部膨隆を主訴に受診した．左鼠径部に鶏卵大の膨隆を認め，左鼠径ヘルニアと診断し，TAPP法を施行した．術中所見は左内鼠径ヘルニア，左大腿ヘルニアを認め，右は認めなかった．術後問題なく退院したが，半年後に術後からの疼痛を主訴に再受診となった．再発の所見はなく，しびれや感覚異常，Tinel徴候は認めなかった．前傾姿勢時のみ疼痛を認めることからメッシュによる機械的圧迫によるものと考えた．3か月の経過観察でも改善がないため，腹腔鏡下メッシュ除去術を施行し，術後疼痛の改善を認めている.ヘルニアに関しては二期的にMesh plug法による修復術を施行した．今回筆者らはメッシュ除去により改善したTAPP術後の慢性疼痛の1例を経験したので報告する．

　The patient was a 64-year-old man who presented with left inguinal swelling since 1 year ago. We diagnosed left inguinal hernia because of an egg-sized bulging was found in the left inguinal region. We performed TAPP repair. Intraoperative findings, a left internal inguinal hernia and a left femoral hernia were noted. Six months after discharge, he was re-examined for pain after surgery. There were no recurrent signs, numbness, sensory abnormalities or Tinel symptoms. We thought that pressure by the mesh was the cause, because the pain was only in the forward posture. There was no improvement after 3 months, therefore, we performed laparoscopic mesh removal and performed mesh plug surgery later for inguinal hernia. We noticed improvement in pain after reoperation. We report a case of chronic pain after TAPP which improved after mesh removal.