胃体部が嵌入し閉塞をきたした傍ストーマヘルニアに対して腹腔鏡下Sugarbaker法を施行した1例

A case of parastomal hernia with incarceration and obstruction of the gastric body successfully treated by laparoscopic Sugarbaker repair

◆要旨：症例は77歳，男性．腹会陰式直腸切断術にて後腹膜経路で人工肛門が造設されていた．7年前から人工肛門尾側に胃幽門部，十二指腸が脱出し，小児頭大の傍ストーマヘルニアを認めていた．通過障害により3か月間に4回の入院を繰り返し，17kg体重が減少したために腹腔鏡下Sugarbaker法を施行した．腹腔内では10×11cm大のヘルニア門を認め，上行結腸から横行結腸，大網がヘルニア囊内へ癒着していた．癒着剝離時に，ヘルニア門外縁で挙上S状結腸の露出を認めた．筋膜縫合しヘルニア門を閉鎖，露出した挙上結腸を後腹膜化した．閉鎖したヘルニア門上にSymbotex^TM composite meshを固定し手術を終了した．術後6日目に自宅退院とした．退院後ヘルニアの再発と通過障害は認めていない．

　A 77-year-old man presented with a parastomal hernia located caudal to a colostomy that had been constructed via the retroperitoneal route following abdominoperineal resection. The hernia, approximately the size of an infant's head, had been present for seven years and involved herniation of the gastric antrum and duodenum. Due to recurrent episodes of bowel obstruction, the patient had been hospitalized four times within the previous three months and experienced a 17kg weight loss. Laparoscopic parastomal hernia repair using the Sugarbaker technique was performed. Intraoperatively, a 10×11cm hernia orifice was identified, with the ascending colon, transverse colon, and omentum adherent within the hernia sac. Following adhesiolysis, the elevated sigmoid colon was exposed at the lateral edge of the hernia orifice. The hernia defect was closed, and the exposed sigmoid colon was retroperitonealized. A Symbotex^TM composite mesh was placed and fixed. The patient was discharged on postoperative day 6 without complications. No recurrence of the hernia or symptoms of bowel obstruction have been observed during the postoperative follow-up period.