腹腔鏡下鼠径ヘルニア修復術後に腹膜縫合部離開による小腸嵌頓をきたした2例

Two cases of small bowel obstruction due to peritoneal suture dehiscence after laparoscopic inguinal hernia repair

◆要旨：症例1の患者は71歳，男性．両側外鼠径ヘルニアに対してTAPPを施行したが，術後2日目に腹膜縫合部離開による小腸嵌頓をきたした．イレウス管で腸管内を減圧した後に腹腔鏡下で小腸を整復し，腹膜縫合離開部を縫合閉鎖した．症例2の患者は55歳，男性．右外鼠径ヘルニアに対してTAPPを施行したが，術後5日目に腹膜縫合部離開による小腸嵌頓をきたした．症例1と同様にして腹腔鏡下で再手術を施行した．TAPP術直後の腸閉塞は腹膜縫合部離開による小腸嵌頓の可能性が高く，早期再手術を検討する必要がある．腹膜縫合部離開を防ぐためには確実な腹膜縫合が必要であり，文献的考察を加えて報告する．

　Case1. A 71-year-old male underwent transabdominal preperitoneal repair （TAPP） for bilateral external inguinal hernia. He developed small bowel obstruction due to peritoneal suture dehiscence on postoperative day 2. After intestinal decompression with a long intestinal tube, the small intestine was reduced laparoscopically, and the peritoneal suture dehiscence was closed by suturing. Case 2. A 55-year-old male underwent TAPP for right external inguinal hernia. He developed small bowel obstruction due to peritoneal suture dehiscence on postoperative day 4. The patient underwent laparoscopic reoperation in the same manner as case 1. Intestinal obstruction immediately after TAPP surgery is likely to be caused by small bowel obstruction due to dehiscence of the peritoneal sutures, and early reoperation should be considered. Secure peritoneal suturing is necessary to prevent peritoneal suture dehiscence. We report these cases with some literature review.