腹腔鏡下で直接縫合とメッシュを併用し修復した肝切除後成人横隔膜ヘルニアの1例

A case of adult diaphragmatic hernia after hepatectomy treated with laparoscopic surgery with direct suturing and mesh placement

◆要旨：患者は62歳，女性．肝外側区域切除術の既往がある．上腹部不快感の精査目的に施行した腹部CTで左横隔膜のドーム部から，胸腔内に胃穹窿部の脱出を認めた．成人横隔膜ヘルニアの診断で，腹腔鏡下ヘルニア修復術を行った．脱出していた胃穹窿部と大網を腹腔内に還納した後，約3cm×3cm程度のヘルニア門を直接縫合で閉鎖し，メッシュで補強した．術後経過は良好で，術後6日目に退院した．術後5か月の時点では再発を認めていない．

　A-62-year-old female had a history of left lateral segmentectomy 6 months ago and she presented with dyspnea and abdominal discomfort. Her abdominal CT scan showed a left diaphragmatic hernia where a part of the gastric fundus was incarcerated. She was diagnosed with an adult diaphragmatic hernia and underwent an elective laparoscopic surgery. The hernia including stomach and greater omentum was reduced into the abdominal cavity without any difficulties, and then, the 3 cm hernia orifice was closed by direct suturing, followed by mesh placement. There were no postoperative complications, and she was discharged on the sixth postoperative day. No recurrence of the diaphragmatic hernia was observed 5 months after the repair.