腹壁ヘルニアに対するTEPの手技を応用した内視鏡下腹膜外修復法

Endoscopic extraperitoneal repair adapted from tep for ventral hernia

◆要旨：腹壁ヘルニアに対する腹腔鏡下鼠径ヘルニア修復術のTEP （totally extraperitoneal repair）の手技を応用した内視鏡下腹膜外修復法の周術期手術成績を報告する．2018年より計13例（男5/女8）の原発性腹壁ヘルニアまたは腹壁瘢痕ヘルニアに施行し，平均手術時間，出血量は，それぞれ212分，9.7mlであった．2例で術中開腹移行したが，術中術後に重篤な合併症はみられなかった．現在までヘルニア再発やメッシュ関連合併症，慢性疼痛などは認めず，短期手術成績は概ね良好と思われた．今後，臨床経験を蓄積し，本手術が腹壁ヘルニアの患者にとり，満足度の高い手術へと発展することが期待される．

　Recent growing evidence highlights the trend of minimally invasive endoscopic extraperitoneal repair for ventral hernia. We adapted the procedure of totally extraperitoneal repair for inguinal hernia to endoscopic surgery for ventral hernia and operated on 13 patients （male 5/ female 8）with either primary ventral or abdominal incisional hernia since 2018. The average operation time and blood loss amounted to 212 min and 9.7 ml, respectively. There was conversion to open procedure in two patients during the operation, but neither serious intra- nor post- operative complication was experienced. To date, no hernia recurrence, mesh-related complications, or chronic pain was observed, revealing the feasibility of the short-term operative outcomes for this procedure. With the accumulation of clinical experiences, further development of this procedure is expected to lead to the satisfaction for patients with ventral hernia.