Parietex ProGripTMを用いTAPP法で修復した腹壁瘢痕ヘルニアの1例

Applying Parietex ProGripTM in laparoscopic transabdominal preperitoneal approach for abdominal incisional hernia repair

◆要旨：症例は72歳，男性．腹腔鏡下幽門側胃切除後臍創部の腹壁瘢痕ヘルニアに対する手術目的に紹介となり，腹腔鏡下手術を施行した．臍創部に6×7cmのヘルニア門を認め，transabdominal preperitoneal approach（以下，TAPP法）に準じて，Parietex ProGrip^TMを腹膜前腔に留置し，修復した．腹壁瘢痕ヘルニアに対する腹腔鏡下手術は，多くが腹腔内留置型メッシュを用いた方法で施行されている．しかし，腹腔内へのメッシュ留置によるメッシュ感染や癒着に伴う腸閉塞，腸管皮膚瘻，またメッシュ固定に伴う急性，慢性疼痛などの合併症が報告され始めている．今回われわれは， 本邦では未施行の，Parietex ProGrip^TMを用いTAPP法で修復した腹壁瘢痕ヘルニアの1例を経験したので，文献的考察を加えて報告する．

　Although benefits of laparoscopic surgery for abdominal incisional hernia have been reported, there are some complications such as mesh infection, bowel obstruction, and enterocutaneous fistula that are deeply related to intraperitoneal mesh placement. Additionally, the common technique of laparoscopic traumatic fixation for mesh sometimes increases the chances of acute and chronic pain. In order to prevent complications and relieve pain associated with intraperitoneal mesh placement, we developed a new surgical technique applying Progrip^TM mesh placement via laparoscopic transabdominal route. No additional fixation system is necessary in the preperitoneal space by using this technique. Here we present an incisional hernia patient who received our new surgical technique. A 72-year-old man visited our hospital, complaining of umbilical wound swelling 6 months after laparoscopic distal gastrectomy for gastric cancer. Abdominal computed tomography showed an abdominal wall defect（6＊7cm） just below the previous umbilical wound. The patient was diagnosed as having abdominal incisional hernia. He underwent laparoscopic hernia repair using transabdominal preperitoneal approach with Parietex Progrip^TM mesh with no complications. Our technique may be useful for patient with abdominal incisional hernia.