腹腔鏡下に修復した外鼠径ヘルニアを合併したSpigelianヘルニアの1例

A Spigelian hernia and inguinal hernia repaired by laparoscopic surgery

◆要旨：患者は60歳，男性．左下腹部違和感を主訴に当院を受診した．腹部CTにて腹直筋左外縁に，筋膜欠損部および皮下に脱出する肥厚した腹膜を認め，左Spigelianヘルニアと診断し，腹腔鏡下ヘルニア根治術を施行した．術中に左外鼠径ヘルニアの合併を認めた．鼠径ヘルニアは腹腔内到達法（transabdominal preperitoneal approach : TAPP法）による修復を施行し，Spigelianヘルニアは別のメッシュを用いて鼠径ヘルニアとは別に修復した．術後経過は良好で，明らかな再発は認めていない．Spigelianヘルニアに対しての腹腔鏡下手術は詳細な検索により，他部位のヘルニア合併の診断や治療を同時に行うことが可能であり，有用であると考えられた．

　A 60-year-old man complained of dysphoria in the left lower quadrant. Abdominal computed tomography showed the absence of muscular fasciae and protrusion of thickened peritoneum at the left lateral margin of the rectus abdominis muscle. A left Spigelian hernia was diagnosed, and laparoscopic surgery was performed. A left indirect hernia was also noticed during surgery. Inguinal hernia was repaired by transabdominal preperitoneal approach, and Spigelian hernia was repaired at the same time using different mesh. Spigelian hernia is a rare disease, but it often occurs with other hernias such as inguinal hernia. It is important to make careful pre and intraoperative diagnosis since laparoscopic surgery can be useful for simultaneous diagnosis and repair.