金属製タックを用いた経腹膜外腔腹腔鏡下鼠径ヘルニア修復術（TEP）後イレウスの1例

Postoperative ileus caused by a metallic spiral tack used for total extraperitoneal laparoscopic inguinal hernia repair : a case report

◆要旨：患者は65歳，男性．3年前当科にて，経腹膜外腔腹腔鏡下両側鼠径ヘルニア修復術（TEP）を施行されていた．患者は腹痛を主訴として来院，機械性イレウスの診断で入院となった．保存的加療を開始したが改善が得られず，開腹下イレウス解除術を施行した．術中所見では，金属製タックにより小腸と腸間膜が固定され，腸閉塞をきたしていた．腸管の壊死はなく，タックの除去のみでイレウスは解除された．イレウスの原因は，TEP施行時，メッシュ固定に用いた金属製タックが脱落し，腹腔内に迷入したためであった．たとえ腹膜外アプローチであっても，金属製タックが術後イレウスの原因となりうることを念頭に置き，その使用には細心の注意を払うべきと考えられた．

　We here report a case of postoperative ileus caused by a metallic spiral tack used for total extraperitoneal laparoscopic inguinal hernia repair（TEP）. A 65-year-old man, who had a history of TEP for bilateral inguinal hernia at the age of 62, came to our hospital with acute abdomen. Imaging examinations revealed mechanical small bowel obstruction without strangulation. Conservative therapy was administered after admission, but his symptoms were not improved. Therefore, we performed surgical procedure on post-admission day 4. The operative findings at laparotomy revealed that the small intestine was fixed with the mesenterium by a metallic spiral tack and the pinning caused the twist and the obstruction. Removal of the tack released the obstruction, and we did not need to perform bowel resection. On post-operative day 13, he discharged without any complications. To best of our knowledge, this is the first report of ileus by a metallic spiral tack used for mesh fixation during TEP. Our report indicates that the use of staples could cause postoperative ileus even though extraperitoneal approach was performed. Careful use of staples is necessary in any operation.