力士に対する腹腔鏡下虫垂切除術の経験

A case of laparoscopic appendectomy for a sumo wrestler

◆要旨：患者は23歳，男性，身長180cm，体重180kg（BMI55.6kg/m²），職業は力士である．繰り返す虫垂炎に対して本人の希望で腹腔鏡下虫垂切除術を施行した．全身麻酔下，仰臥位で手術を開始した．臍部に20mmの皮膚切開を置き，計4ポート留置した．気腹法のみでは視野は非常に悪かったが，右下腹部に腹壁吊り上げ法を併用したところ良好な視野を確保できた．比較的容易に虫垂を同定し切除した．手術翌日から食事・離床を進め，経過良好で術後4日目に退院した．退院後経過も良好で競技生活に支障は認めていない．力士は脂肪，筋肉の付き方が特異的である．気腹法に腹壁吊り上げ法を併用することで良好な術野を得ることができた．

A 23-year-old male sumo wrestler, with a height of 180 cm, body weight of 180 kg and BMI of 55.6kg/m², presented with recurrent appendicitis and underwent laparoscopic appendectomy at his own request. The operation was performed under general anesthesia in a supine position. A 20-mm umbilical incision was made and a total of 4 ports were placed. Since abdominal insufflation alone provided a very poor operative view, abdominal wall lift was also applied to the right lower abdomen, affording a good operative view. This technique allowed for the relatively easy identification and removal of the appendix. The patient was allowed to eat and get out of bed the day after the operation. He had a favorable postoperative course and was discharged 4 days after the operation. His postoperative course was uneventful and has had no impact on his competitive career. Sumo wrestlers are not only severely obese, but also very muscular, a feature that is distinct from pathological obesity. The combination of the technique of abdominal insufflation and abdominal wall technique provided us a very good operative view．