再発閉鎖孔ヘルニアに対するメッシュ・プラグによる腹腔鏡下修復術の1例

Laparoscopic hernia repair with mesh plug for recurrent obturator hernia : A case report

◆要旨：患者は94歳，女性．2005年6月，左閉鎖孔ヘルニアに対し開腹下ヘルニア修復術を受けた．2006年8月，腹痛と左大腿部のしびれを主訴に当院救急外来を受診した．腹部CTで左恥骨筋と外閉鎖筋の間に嵌頓した小腸を認め，閉鎖孔ヘルニアと診断し緊急手術を施行した．腹腔鏡下で観察すると，左閉鎖孔に全係蹄型に嵌頓した小腸を認めた．愛護的に腸管を引き出した後，ヘルニアサックを翻転・切除した．メッシュ・プラグを閉鎖管に挿入して腹膜を縫合閉鎖した．術後経過は良好で，術後10か月経過現在，再発を認めていない．閉鎖孔ヘルニアに対する腹腔鏡下プラグ法は低侵襲，簡便かつ安全であり，緊急手術時の高齢者に対しても施行しうる術式であると考える．

　A under weight 94-year-old woman was admitted to our hospital with abdominal pain and numbness of the left medial thigh in August, 2006. She had undergone an open surgical hernia repair for a left obturator hernia in June, 2005. A pelvic CT scan showed the small intestine incarcerated between the left peritoneal muscle and external obturator muscle. She was diagnosed as an obturator hernia, and emergent surgery was performed. Intra-abdominal inspection during laparoscopy showed a complete herniation of the ileal loop into the left obturator canal. The hernia was carefully reduced by traction, and the hernial sac inverted and excised. A mesh plug was inserted into the obturator canal and the peritoneum sewn closed. The postoperative course was uneventful, and no recurrence was experienced in the ten months after the surgery. This case demonstrated that laparoscopic obturator hernia repair with mesh plug is less invasive, simple and safe. It is also feasible for the elderly even in emergent surgery.