腹腔鏡下手術が有用であった傍裂孔ヘルニアを合併した食道裂孔ヘルニアの1例

Esophageal hiatal hernia complicated with parahiatal hernia diagnosed and treated by effective laparoscopic surgery

◆要旨：患者は79歳，女性．食道裂孔ヘルニアと診断され近医で内服治療されたが，体重減少も認め治療目的に紹介となった．upside down stomach合併の食道裂孔ヘルニアと診断し腹腔鏡下手術を開始した．術中，左右横隔膜脚の開大とともに右横隔膜脚内にヘルニア門を認め，傍裂孔ヘルニアを合併した食道裂孔ヘルニアと診断した．ヘルニア門を縫合閉鎖し，噴門形成術を追加した．経過良好で，術後半年現在，症状は特になく体重は増加し，再発も認めていない．非常に稀である傍裂孔ヘルニアを合併した食道裂孔ヘルニアに対し，腹腔鏡下手術は陽圧下での食道裂孔部の詳細な観察と根治術が可能であり，有用な術式の1つであると考えられた．

　A 79-year-old woman, diagnosed with esophageal hiatal hernia, was initiated medical management. Her anorexia was uncontrollable with medical therapy, and developed to severe weight loss. We preoperatively diagnosed this case as esophageal hiatal hernia with upside down stomach in upper gastrointestinal series, and performed laparoscopic surgery. We found a hernia orifice between both crura of diaphragm, and another hernial orifice separately on the right side of esophageal hiatus. Because there was the crus of diaphragm between the hiatus and the orifice, the definitive diagnosis was a parahiatal hernia . Both hernial orifices were sutured and closed, and fundoplication was added. She was discharged without complication. A half year after surgery the patient`s condition is good, and has been no recurrence of the hernia. Esophageal hiatal hernia complicated with parahiatal hernia is extremely rare, but laparoscopic surgery is useful for diagnosis and curative treatment of this.