両側鼠径部ヘルニアに対する対側腹膜外腔到達法（contralateral TEP）手技を用いた片側腹膜切開による経腹的腹膜前到達法（膨潤TAPP法）の安全性

Safety of tumescent TAPP with contralateral TEP approach for adult bilateral inguinal hernias

◆要旨：両側鼠径部ヘルニアに対し，腹膜切開および腹膜縫合操作を省略する目的で，対側腹膜外腔到達法（contralateral TEP）手技を用いた片側腹膜切開による経腹的腹膜前到達法（膨潤TAPP法）を施行した7例を報告する．病変として優位な片側の鼠径部ヘルニアに対し膨潤TAPP法を施行し，同腹膜切開部から対側の腹膜切開を追加せず，対側の鼠径部ヘルニアの腹膜剝離を腹膜前到達法で行う．腹膜非切開側，腹膜切開側の順にメッシュ挿入固定，同腹膜切開部を縫合閉鎖し手術を終了する．全症例で術中偶発症や重篤な術後合併症，再発を認めていない．両側鼠径部ヘルニアに対しcontralateral TEP手技を用いた膨潤TAPP法は安全に施行可能な手技である．

　We report 7 cases of bilateral inguinal hernias treated by laparoscopic tumescent transabdominal preperitoneal approach（tumescent TAPP） with unilateral peritoneal incision using the contralateral totally extraperitoneal（TEP） approach to omit just another unilateral peritoneal incision and peritoneal suture. First, we performed tumescent TAPP for a dominantly unilateral lesion of bilateral inguinal hernias. Next, the peritoneal dissection of the opposite inguinal area was performed through the peritoneal incision with the contralateral peritoneum（TEP approach） using tumescent local anesthesia solution. After inserting and tacking the contralateral mesh, the mesh on the side of the peritoneal incision was inserted and tacked. The peritoneum was then closed and the operation was completed. All patients underwent tumescent TAPP with contralateral TEP approach without intraoperative incidents, postoperative severe complications, and recurrences. Tumescent TAPP with contralateral TEP approach is a safe procedure for adult bilateral inguinal hernias.