大腿ヘルニア嵌頓に対し腹膜外腔アプローチによる内視鏡下ヘルニア修復術を行った1例

A case of incarcerated femoral hernia treated with laparoscopic hernia repair by totally extraperitoneal approach

◆要旨：患者は84歳の男性で，左鼠径部膨隆および疼痛を認めたため当科を紹介され入院した．腹部CT検査で左大腿ヘルニア嵌頓と診断した．ヘルニア内容は大網と考えられた．腸閉塞症の所見は認めなかったため，待機的に腹膜外腔アプローチによる内視鏡下ヘルニア修復術を行った．内視鏡下に観察すると，大腿輪にヘルニア囊が陥入していた．鉗子による牽引でヘルニア囊を整復し，大腿輪を確実に覆うようにメッシュを貼付した．術後経過は順調であり，第4病日に退院となった．術後5か月が経過した現在，再発や感染の徴候は認めていない．確実な診断と修復が行える腹膜外腔アプローチによる内視鏡下ヘルニア修復術は大腿ヘルニア嵌頓に対し有用な術式である．

　Reports of incarcerated femoral hernias treated with laparoscopic surgery are rare. We report such case treated laparoscopically with totally extraperitoneal approach. An 84-year-old man visited our hospital complaining of pain and bulging of the left groin region. The incarcerated hernia in the left groin lesion could not be reduced manually. Based on abdominal computed tomography, a diagnosis of left femoral hernia whose content was fat tissue was made. Since there were no clear findings of intestinal obstruction and peritonitis, elective laparoscopic hernia repair by totally extraperitoneal approach was performed. Laparoscopy showed that the hernia sac had herniated into the left femoral canal. However, we were able to release the hernia sac using laparoscopic forceps. The femoral canal was then covered by 3D MAX mesh. Postoperative course was uneventful, and the patient was discharged from the hospital, 4 days after surgery. There is no sign of recurrence or mesh-related infection, 5 months after surgery. Laparoscopic hernia repair by totally extraperitoneal approach is useful for both diagnosis and treatment of incarcerated femoral hernia.