成人鼠径ヘルニアに対するtransabdominal preperitoneal repair（TAPP）法におけるパリテックスTM ラップ プログリップTM メッシュ展開法の工夫

A method of transabdominal preperitoneal repair using ProGripTM Laparoscopic Self-Fixating Mesh for adult inguinal hernia

◆要旨：Transabdominal preperitoneal repairに用いるProGrip^TM（COVIDIEN社製）は，マイクログリップにより面で組織に固定する．その強固な固定性により配置，展開が難しい．本法は，前処置としてメッシュ上縁から3cmに横線を引き，横線より下方部分を横線まで2回折り込み，もう一度横線で折り込む．腹膜前腔で内側は腹直筋外縁より内側に3cm，上縁は内鼠径輪の直上にメッシュを配置する．初めにメッシュを腹側に展開し，次に背側に2回展開する．筆者らは，メッシュのmigrationによる再発予防のため安全域を3cm確保し，容易に適正な位置に配置，展開可能な方法を考案した．

ProGrip^TM（COVIDIEN Co.） used for transabdominal preperitoneal repair is an innovative mesh, the entire surface of which fixates to abdominal wall by means of microgrip mechanism. Due to its potent fixative property, however, it is difficult to place the mesh on optimal position, and to expand appropriately in preperitoneal space. We propose a modified method to save such troubles. Before applying to the body, a straight line is drawn as a marker at 3cm inside from the upper margin of the mesh. The lower part under the line is then folded twice toward the line to get three equal parts. The folded mesh is again folded at the marker line. In preperitoneal cavity, the bottom side of the folded mesh is placed at 3cm inward from outer edge of rectus abdominis, and the upper margin of the mesh is located immediately above the internal inguinal ring. The mesh is at first unfolded to the ventral direction, then twice to the dorsal. Our method makes it easier to locate and spread the mesh in the correct position. Furthermore, securing 3cm safety margin of the mesh is beneficial to prevent relapse of hernia due to migration of the mesh.