eTEPを用いた内視鏡下腹壁瘢痕ヘルニア修復術の手術成績：腹腔鏡下IPOM修復術との比較

Operative outcomes of ventral incisional hernia repair using eTEP techniques : comparison with laparoscopic IPOM

◆要旨：当科で過去8年間に内視鏡下に腹壁瘢痕ヘルニア修復術を行った65例のなかで嵌頓臨時手術例を除いた60例のうち，IPOM 31例とeTEP 29例を後ろ向きに比較検討した．患者の年齢・性別・BMI・ヘルニア門の横径・ヘルニア門部位について両群間で差は認めなかった．eTEP群でメッシュ面積が752 vs 319cm²と大きく，手術時間が340 vs 167分と長かった．術中出血量と術翌日CRP値に差を認めなかった．また，術後在院日数は両群とも6日と差を認めなかった．IPOM群でメッシュ感染と再発をそれぞれ1例に認めたが，eTEP群では合併症を認めなかった．IPOMと比較して，eTEPは大きなメッシュを腹膜外に留置できる点で優れるが，今後のさらなる手技の洗練によって手術時間の短縮が必要である．

　Although intraperitoneal onlay mesh repair（IPOM）has been one of the standard treatments for abdominal incisional hernia repair, it has gradually reduced its favor because of severe postoperative pain and long-term mesh-related complications. On the other hand, enhanced view-totally extraperitoneal technique（eTEP）, which allows for mesh placement in the extraperitoneal space without tight mesh fixation, has started to gain attention. We retrospectively compared 31 cases of IPOM and 29 cases of eTEP（excluding strangulation cases）among 65 patients who had undergone endoscopic incisional hernia repair of the abdominal wall in our department over the past eight years. There were no differences in patient age, gender, BMI, the transverse diameter of the hernia orifice, or location of the hernia orifice between the two groups. The eTEP group had a larger mesh area（752 vs. 319 cm²）and a longer operation time（340 vs. 167 minutes）. There was no difference in intraoperative blood loss and CRP levels measured the day after the surgery. One case of mesh infection and recurrence was observed in the IPOM group, whereas no complication was observed in the eTEP group. Therefore, eTEP is a feasible and safe procedure and is superior to IPOM because a larger mesh can be placed. However, further refinement of the technique is needed to reduce the operation time.