メッシュを用いたSandwich法で修復し得た再発横隔膜へルニアの1例

A case of recurrent diaphragmatic hernia repaired by the Sandwich mesh technique

◆要旨：患者は40代男性．3年前にStanford A型解離に対して弓部大動脈置換術を施行されている．1年後，感染性大動脈瘤切迫破裂を発症し左開胸開腹下での胸部下行大動脈置換術，経横隔膜的有茎大網充塡術を行った．術後12日目に大網充塡経路から横隔膜へルニアを発症し胃の嵌頓を認めたため，直接縫合で腹腔鏡下へルニア修復術を施行した．6か月後，嘔吐と左上腹部痛を主訴に当院を受診し，横隔膜へルニア再発を認め当科に紹介となった．Sandwich法を用いた腹腔鏡下修復術を検討したが，医療資源準備の観点から二期的に施行した．術後経過は良好で，術後3日目で退院となった．現在，術後5か月経過したが，再発は認めていない．

　The patient was a man in his 40s who underwent aortic arch replacement for Stanford type A dissection three years ago and developed imminent rupture of an infected aortic aneurysm a year later, for which he underwent left thoracotomy for thoracic descending aorta replacement and transdiaphragmatic pedicled omental flap transposition. On the 12th day after the operation, a diaphragmatic hernia developed from the omentoplasty, and gastric incarceration was confirmed. Laparoscopic hernia repair was performed with direct suture. Six months later, the patient visited our hospital complaining of vomiting and left upper quadrant pain. We considered laparoscopic repair using the Sandwich method ; the procedure was performed in two stages due to perspectives of medical resource preparation. The postoperative course was favorable, and the patient was discharged from the hospital on the 3rd day postoperatively. Five months have passed since the operation, and no recurrence has been observed.