腹腔鏡下スリーブ状胃切除後の食道裂孔ヘルニアに対して腹腔鏡下修復術を施行した1例

A Case of hiatal hernia after sleeve gastrectomy

◆要旨：症例は39歳，女性．高度肥満症に対して腹腔鏡下スリーブ状胃切除術を施行1年半後に食思不振と心窩部痛を主訴に来院．初回手術時には食道裂孔の縫縮や食道と脚の固定は施行しなかった．CTで縦隔内にスリーブ胃と横行結腸が嵌入し，スリーブ胃の捻転を認めた．食道裂孔ヘルニアと診断し修復術を施行した．手術は腹腔鏡下にスリーブ胃と横行結腸を腹腔内に還納し，食道裂孔を非吸収糸で縫縮，腹部食道を横隔膜脚，スリーブ胃を横行結腸間膜に固定した．術後経過良好で術後8日目に退院した．腹腔鏡下スリーブ状胃切除後には稀に修復術が必要な食道裂孔ヘルニアを発症しうるので，術後の合併症として認識しておく必要がある．

　The patient was a 39-year-old woman. One and a half years after laparoscopic sleeve gastrectomy for morbid obesity, she came to our hospital with complaints of anorexia and epigastric pain. Hiatal repair and fixation of the esophagus and hiatus was not performed at the first operation. CT scan showed that the sleeve remnant and transverse colon were inserted into the mediastinum and the sleeve remnant was twisted. The patient was diagnosed with hiatal hernia and underwent reoperation by laparoscopic surgery. The sleeve stomach and transverse colon could be easily returned into the abdominal cavity. After the esophageal hiatus was repaired using non-absorbable thread, the abdominal esophagus was fixed to the left diaphragmatic crura, and the sleeve remnant was fixed to the retroperitoneum, respectively. The patient was discharged on the eighth postoperative day without postoperative complications. Hiatal hernia requiring repair is a rare complication after laparoscopic sleeve gastrectomy and should be recognized as a postoperative complication.