内視鏡下transversus abdominis muscle release（eTEP-TAR）法を用いて腹壁瘢痕ヘルニア修復を行った1例

A case of a ventral incisional hernia repaired using endoscopic transversus abdominis muscle release technique

◆要旨：76歳，女性．2年前に大腸癌に対して腹腔鏡下結腸右半切除術後であり，臍部の膨隆と疼痛を主訴に来院し，腹部CTで横径55mmの腹部正中切開創部の腹壁瘢痕ヘルニアと診断された．術前は内視鏡下Rives-Stoppa法を予定していたが，後鞘の緊張が強く寄らなかったことから右側のみtransversus abdominis muscle release（TAR）法を施行し，縦30cm×横15cmのself-gripping meshを用いて修復した．合併症なく術後3日で自宅退院となり，退院時には疼痛は消失していた．術後9か月経過したが，再発や合併症を認めていない．

　A 76-year-old woman, who had undergone laparoscopic right hemicolectomy for colon cancers two years previously, presented our department with a complaint of a bulge and pain around the umbilicus. Computed tomography scan indicated a diagnosis of incisional hernia, in which the orifice diameter was 55mm. The endoscopic Rives-Stoppa technique was planned preoperatively, but additional transversus abdominis muscle release was necessary on the right side due to the tight tension of the posterior layer. The patient was discharged 3 days after the operation without pain. She remained asymptomatic 9 months after the operation.