人工心肺の送脱血カニューレ挿入による鼠径部腹壁瘢痕ヘルニアをTAPP法で修復した1例

Transabdominal preperitoneal repair of an abdominal incisional hernia in the inguinal region caused by vessel cannulation for cardiopulmonary bypass

◆要旨：症例は77歳，女性．約1年前に急性大動脈解離に対する上行置換術後の遠位吻合部仮性瘤に対する手術を施行した．このとき，人工心肺を装着する際に右鼠径部を切開して直視下に右大腿動静脈から送脱血カニューレを挿入した．5か月後，右鼠径部に膨隆がみられ，8か月後に当院を紹介受診した．右鼠径部の腹壁瘢痕ヘルニアの診断となり，transabdominal preperitoneal approach（TAPP）法に準じて高位切開法で腹腔鏡下腹壁瘢痕ヘルニア手術を施行した．人工心肺の送脱血カニューレの挿入は，鼠径部を切開して行うことがあるが，稀に腹壁瘢痕ヘルニアになることがある．その治療法として，TAPP法に準じた腹腔鏡下手術は，確実なヘルニア修復および低侵襲性の点から有用な方法である．

　A 77-year-old woman underwent surgery for a distal anastomotic pseudoaneurysm after ascending aortic replacement for acute aortic dissection. During the surgery, arterial and venous cannulation was performed in the right inguinal region for cardiopulmonary bypass. Five months later, she developed an elevation in the right groin, and 8 months later, she was referred to our hospital. An abdominal incisional hernia in the right inguinal region was diagnosed, and laparoscopic transabdominal preperitoneal hernia repair was performed. A mesh was placed in the exfoliated anterior peritoneal cavity and anchored with tacks. The peritoneum was sutured in the abdominal cavity. Vessel cannulation may be performed in the inguinal region for cardiopulmonary bypass; in rare cases, however, this may result in an abdominal incisional hernia. Laparoscopic transabdominal preperitoneal repair is a useful treatment method for such hernias because of its reliability and minimal invasiveness.