腹腔鏡下修復術が有用であったスピーゲルヘルニアの1例

A case of Spigelian hernia in which laparoscopic repair was useful

◆要旨：患者は73歳，男性．約2年前より時々右下腹部痛があったため，腹部CT検査を施行したところ，右腹直筋外縁に脱出する腸管が認められ，スピーゲルヘルニアと診断した．膨隆がみられず，体表からはヘルニア門の触診が困難であったこと，開腹既往がなかったことから，術式は，腹腔鏡下修復術を選択した．右腹直筋外縁のスピーゲル腱膜部に径約2cmのヘルニア門を認め，9cm円型Parietex^TM Composite（PCO）meshを用いて修復した．スピーゲルヘルニアに対する腹腔鏡下修復術は，ヘルニア門の正確な術中診断が可能であることからよい適応であり，体表からヘルニア門の同定が困難であった本症例では，特に有用であった．

The patient was a 73-year-old man who had sometimes experienced right lower quadrant pain since approximately two years prior. Thus, he underwent abdominal CT examination. There was a prolapsed intestine at the lateral border of the right rectus abdominal muscle, and the patient was diagnosed with Spigelian hernia. There was no distension, it was difficult to palpate the hernial orifice from the body surface, and the patient had no history of laparotomy. Therefore, laparoscopic repair was selected as the surgical procedure. A hernial orifice was observed with a diameter of approximately 2cm at the Spigel aponeurosis of the outer border of the right rectus abdominal muscle. The repair was performed using a 9-cm, round Parietex composite （PCO） mesh. Laparoscopic repair is well indicated for Spigelian hernia because it can provide an accurate intraoperative determination of hernia orifice. This procedure was particularly useful in our case in which identification of hernial orifice was difficult from the body surface.