前回術式と再発形式から考える再発鼠径部ヘルニアに対する治療戦略

Treatment strategy for recurrent groin hernia based on previous surgical methods and recurrence types

◆要旨：2013年4月から2022年4月までに当科で手術を行った再発鼠径部ヘルニア100例を対象とし，前回術式別の術式選択と成績を検討した．前方到達法後再発74例中71例でTAPP法を行い，再発は1例で合併症はなかった．腹腔内または腹膜前到達法後再発26例中10例でTAPP法を試みたが，外鼠径ヘルニア型再発2例で腹膜閉鎖が困難であった．1例はIPOM変法に移行し，1例は術後，腹膜離開による腸閉塞をきたした．再発鼠径部ヘルニアに対するTAPP法は，腹腔内から良好な視野で再発形態の診断と修復ができるという利点があるが，腹腔内または腹膜前到達法後外鼠径ヘルニア型再発症例に対しては，前方到達法を選択すべきである．

　We examined 100 patients with recurrent groin hernias who underwent surgery at our department from April 2013 to April 2022, together with the surgical selections and results of previous surgical procedures. TAPP was performed in 71 of the 74 patients enduring recurrences after an anterior approach, resulting in one further recurrence and no complications. TAPP was attempted in 10 of the 26 patients who had experienced recurrence after a posterior approach. Of these, peritoneal closure was found to be difficult in two patients with indirect hernia-type recurrences. A Modified IPOM was performed in one patient, and in the other patient, an intestinal obstruction due to peritoneal dehiscence was found to have followed surgery. Although the TAPP method for recurrent groin hernias has the advantage of providing accurate diagnoses and repair, and a good view from the abdominal cavity, the anterior repair should be selected for cases of indirect inguinal hernia-type recurrences after preperitoneal mesh repair.