単孔式腹腔鏡下に修復し得たSpiegelヘルニアの1例

Single-incision laparoscopic-assisted intraperitoneal hernioplasty for Spiegelian hernia

◆要旨：Spiegelヘルニアに対して単孔式腹腔鏡下修復術を施行した1例を経験したので報告する．患者は76歳，男性．左下腹部の腫瘤を主訴に来院した．左下腹部に弾性軟で鶏卵大の腫瘤を認めた．腹部造影CT検査にて腹直筋左外縁に欠損部と脂肪組織の脱出を認めた．左Spiegelヘルニアと診断し，単孔式腹腔鏡下修復術を施行した．腹腔鏡下に観察すると左腹直筋の外縁に約2cmのヘルニア門を認め，Spiegelヘルニアと診断した．ヘルニア門と周囲の脆弱な部位をデュアルメッシュ^®を用いて腹腔内より固定し，ヘルニア修復術を施行した．術後3日目に軽快し，退院した．現在まで再発の徴候はない．

　We report a patient with Spiegelian hernia which was restored by single incision laparoscopic repair. A 76-year-old male presented with egg size lump in the left lower abdomen. There was no history of local trauma or indication of intestinal obstruction. Physical examination revealed an elderly patient in satisfactory general health with no associated major systemic illness. Abdominal computed tomography revealed a defect to the outside edge of the left rectus muscle and a protrusion of adipose tissue under the external oblique aponeurosis. A diagnosis of Spiegelian hernia was made, and single incision laparoscopic repair with Dual Mesh^® was performed. Under laparoscopic view, the defect of the fascia was 2cm in diameter and was located at the outer edge of the left rectus muscle. Dual Mesh^® was patched covering the orifice laparoscopically. The length of hospital stay was 3 days. There were no intra- and post-operative complications, and there was no recurrence.