食道アカラシア術後の食道裂孔ヘルニアに対し腹腔鏡下修復術を施行した1例

Esophageal hiatal hernia treated by laparoscopic surgery after fundic patch operation

◆要旨：患者は62歳，女性．約30年前，食道アカラシアに対するfundic patch operationの既往があり，今回は繰り返す嘔吐を主訴として来院した．CTで胃のほぼ全体が縦隔内に脱出していることが認められ，食道裂孔ヘルニアと診断された．上部消化管内視鏡での整復ができず，手術になった．左開胸下での食道アカラシア術後のため，腹腔鏡下で食道裂孔を縫縮し，胃体部を横隔膜脚に縫合固定する修復術を施行した．術後透視では胃底部の一部は縦隔内に認められたが，造影剤の流れは良好で，逆流もなかった．現在は症状も改善し，経過良好である．

A 62-year-old woman who had fundic patch operation for esophageal achalasia about 30 years ago was admitted to our hospital for repeated vomiting. The stomach was at a higher level than the diaphragm on CT examination. Since the stomach could not be restored into the abdomen by upper gastrointestinal endoscopy, surgery was performed. The esophageal hiatus was narrowed by suture placement and the posterior gastric body was fixed to the diaphragmatic crus during laparoscopic surgery in order to prevent the reconstituted stomach from sliding back into the chest cavity. Though postoperative upper gastrointestinal radiography showed a portion of the gastric fundus to be in the mediastinum, there was neither retention of a contrast medium in the esophagus nor gastroesophageal reflux. Her postoperative course has been uneventful and the repair yielded excellent results without symptoms.