側方経路腰椎椎体間固定術後に発症したSpigelian herniaをTEP法で修復した1例

A case of Spigelian hernia treated with totally extraperitoneal hernia repair after lateral interbody fusion

◆要旨：患者は78歳，女性．腰部脊柱管狭窄症に対して側方経路腰椎椎体間固定術が行われ，その後から左下腹部の膨隆感を訴えるようになった．視触診では腹部皮下の膨隆やヘルニア門を確認できなかったが，腹部CTで左腹直筋外縁と腹横筋間から腸管が脱出していたためSpigelian herniaを疑った．Totally extraperitoneal（TEP）法による修復術を施行した．腹膜前腔の広範な剝離は可能であり，左内鼠径輪の頭外側に腹横筋腱膜の欠損を認め，Spigelian herniaと確定診断した．側方経路脊椎手術後のSpigelian herniaに対してTEP法は有用な術式であった．

　A 78-year-old woman was admitted to our hospital for a bulging in her left lower quadrant subsequent to lateral interbody fusion for lumbar spinal canal stenosis. We could not confirm whether the bulging originated in the abdomen's subcutaneous tissue or a hernia orifice during clinical examination. However, abdominal computed tomography findings were suggestive of Spigelian hernia because the intestinal tract had prolapsed between the outer layer of the left rectus abdominis muscle and the transverse abdominis muscle. Totally extraperitoneal （TEP） hernia repair was performed. The peritoneal anterior cavity was peeled off in the caudal direction, and the abdominal transverse muscles on the outer side and the Cooper ligament on the inside were identified. An exterior defect of the abdominal transversalis aponeurosis was found 2 cm from the left internal inguinal ring. We confirmed the diagnosis of Spigelian hernia based on the intraoperative findings. TEP was effective for Spigelian hernia after spinal surgery through the retroperitoneal approach.