両側鼠径ヘルニアを伴う左Spigelianヘルニアに対してTEP法にて同時修復を行った1例

A case of Spigelian hernia with bilateral inguinal hernia successfully treated by totally extraperitoneal approach

◆要旨：患者は59歳，男性．数か月前からときどき左下腹部痛と同部の膨隆を自覚して当院を受診した．初診時には症状の訴えはなく，左下腹部には膨隆を認めず，右鼠径部の膨隆を認めるのみであった．腹部単純CTにて下腹部左腹直筋外縁にヘルニア門を認め，外腹斜筋腱膜下に脂肪組織の脱出を認めた．また左側鼠径部にM型の脂肪脱出と右鼠径部に腸管脱出を認めた．左Spigelianヘルニアと両側鼠径ヘルニアと診断し，主訴はSpigelianヘルニアによる疼痛と考えられたが，同時手術を希望したため腹腔鏡下にTEP法で同時修復を施行した．手術時間は182分，出血量は5gで，術後経過は良好で再発も認めていない．本邦ではSpigelianヘルニアに対してTEP法を施行した症例は少なく，鼠径ヘルニアを合併することもある本疾患に対してTEP法は有用であると考えたので，文献的考察を加えて報告する．

　A 59-year-old man visited our hospital because he sometimes experienced pain and swelling on the left lower-abdominal lesion. At the initial physical examination, there was no symptom but we found a swelling at the right inguinal lesion. Abdominal computed tomography showed a prolapse of fat tissue from a hernia orifice under the left external abdominal oblique muscle at the lateral edge of the left rectal muscle ; prolapse of fat tissue and small intestine was also noted from the left and right inguinal lesion, respectively. He was diagnosed as having left Spigelian hernia and bilateral inguinal hernia, and underwent laparoscopic repair by totally extraperitoneal approach. During the surgery, we confirmed the hernia orifices at the left Spigelian hernia belt and bilateral Hesselbach's triangle. These orifices were repaired with three sheets of mesh simultaneously. The operative time and estimated blood loss were 182min and 5g, respectively. The postoperative course was uneventful without recurrence. We herein report that totally extraperitoneal approach was useful for managing Spigelian hernia with inguinal hernia, with a review of the literature.