腹腔鏡下直接縫合とメッシュ補強を併施した胃嵌頓をきたした横隔膜傍裂孔ヘルニアの1例

A case of parahiatal hernia with gastric incarceration repaired by laparoscopic direct suture combined with mesh reinforcement

◆要旨：症例は81歳，女性．心窩部痛，嘔吐，食思不振で近医から紹介され，上部消化管内視鏡検査，上部消化管X線造影検査とCTで，胃が嵌頓した傍食道型食道裂孔ヘルニアや横隔膜ヘルニアを疑い，腹腔鏡下手術を行った．食道裂孔は正常で，ヘルニア門は横隔膜左脚の外側に存在していたため横隔膜傍裂孔ヘルニアと診断した．胃を整復後にヘルニア門を縫合閉鎖し，Ventralight ST^TMメッシュで補強した．術後1年2か月経過しヘルニア再発を認めていない．横隔膜傍裂孔ヘルニアは非常に稀な疾患で，標準術式は定まっていない．IPOM（intraperitoneal onlay mesh）plusに準じて腹腔鏡下直接縫合とメッシュ補強を併施した1例を報告する．

　An 81-year-old female was referred to our hospital with epigastralgia, vomiting, and appetite loss. Based on upper gastrointestinal endoscopy and X-ray, and CT findings, a paraesophageal hiatal hernia or a diaphragmatic hernia with gastric incarceration were suspected. Laparoscopic surgery was performed. An esophageal hiatus was intact, and the hernia defect was located lateral to the left crus of the diaphragm. From these findings, the patient was diagnosed as parahiatal hernia. The stomach was repositioned. The hernia defect was directly sutured and reinforced with Ventralight ST mesh. No recurrence of hernia was observed in one year and two months after the operation. Parahiatal hernia is a very rare disease and the standard procedure has not been established. We report a case of laparoscopic direct suture combined with mesh reinforcement in accordance with IPOM （intraperitoneal onlay mesh） plus.