Morgagni-Larrey孔ヘルニアに対し腹壁外結紮法を併用した腹腔鏡下ヘルニア修復術の1例

A case of Morgagni-Larrey hernia repaired by laparoscopic surgery using extra abdominal suture method

◆要旨：患者は92歳，女性．腹痛，嘔吐が出現したため当院を受診した．腹部CT検査にて胃幽門部と横行結腸の右胸腔内への脱出が認められ，横隔膜ヘルニアと診断した．保存的治療で軽快したが，経口摂取を開始すると症状が増悪するため，腹腔鏡下ヘルニア修復術を行った．術中所見では，大網，胃幽門部，横行結腸が肝鎌状間膜の左側より右胸腔内へ脱出しており，Morgagni-Larrey孔ヘルニアと診断した．ヘルニア門を腹壁外結紮法を用い閉鎖し，Composix Mesh^Ⓡ（メディコン）　で補強した．術後経過は良好であった．本疾患に対する腹腔鏡下修復術は安全に施行できる低侵襲な術式であり，腹壁外結紮法は，ストレスなく，安全確実に施行できる有用な手技であった．

We herein describe the case of a 92-year-old woman who presented to our hospital with abdominal pain and vomiting. Preoperative studies diagnosed her illness as retrocostoxiphoid hernia. Herniation of transverse colon and stomach into the right thoracic cavity was revealed on chest X-ray and computed tomography. At first, the symptoms were relieved by a conservative treatment. However, when an oral feeding was started, the symptoms reappeared. Then, laparoscopic surgery was performed. Laparoscopy showed that the transverse colon, greater omentum, stomach and duodenum were incarcerated through the foramen on the left side of the round ligament of liver. A diagnosis of Morgagni-Larrey hernia with a hiatus of 4×8 cm in diameter was made. Herniated organs were repositioned easily. The defect of diaphragm was closed by extracorporeal sutures and a mesh sheet was applied for precaution. The postoperative course was uneventful. Morgagni-Larrey hernia is a rare type of diaphragmatic hernia. We consider that this laparoscopic technique using extracorporeal sutures and mesh is stressless and eligible for retrocostoxiphoid hernia.