Spigelian hernia beltに発生したSpigelianヘルニアに対しTAPP法で修復を行った1例

A case of Spigelian hernia on Spigelian hernia belt performed laparoscopic surgery by transabdominal preperitoneal approach

◆要旨：Spigelian hernia beltから発生したSpigelianヘルニアに対し，TAPP法で修復した症例を経験した．患者は59歳，女性．腹痛を主訴として当院を受診した．CT検査で腹直筋外側から虚血所見のない小腸の脱出を認めSpigelianヘルニアと診断を得た．用手還納は不可能であった．左腹部に3ポートを配置，腹膜を剝離したのち10×15cmのメッシュを留置した．術後経過は良好で，現段階で再発は認めていない．鼠径部に発生するSpigelianヘルニアの報告は散見されるが，Spigelian hernia beltから発生したものをTAPPで修復した報告は少ない．比較的頭側にヘルニア門が位置するSpigelianヘルニアに対してもTAPPは治療法の一つとなりうると考える．

　This report details that a case of Spigelian hernia on Spigelian hernia belt was treated using laparoscopic TAPP approach. A 59-year-old woman came to our hospital because of abdominal pain.

　CT showed a protrusion of small intestine at the lateral edge of the right abdominal rectus muscle on Spigelian hernia belt. There was no evidence of obstruction and strangulation of small intestines. we could not reduce the incarcerated hernia. She was diagnosed with a Spigelian hernia and underwent operation. We placed three ports at the left side of abdomen, created preperitoneal space and covered the hernia orifice with 10×15cm mesh. The postoperative course was non-eventful without recurrence.

　It is a rare case that Spigelian hernia on Spigelian hernia belt was treated by TAPP approach. TAPP might be an effective option for the treatment of Spigelian hernia on Spigelian hernia belt.