腹腔鏡下Sandwich plus法を行った傍ストーマヘルニアの1例

A case of parastomal hernia treated by laparoscopic Sandwich plus method

◆要旨：傍ストーマヘルニアはストーマ造設後の最も多い合併症であるが，定型化された標準術式はない．メッシュを利用する術式は再発率が低く推奨されており，腹腔鏡下のKeyhole法やSugarbaker法が報告されている．近年は，その2つを組み合わせたSandwich法がより再発率が低いと報告されており，可能であればSandwich法を施行することが望ましい．今回ヘルニア門を縫縮し，さらにKeyhole法と自作したメッシュを使用したSugarbaker法を組み合せ，Sandwich plus法を施行し，良好な経過を得た．両法を組み合わせた本術式は傍ストーマヘルニア修復に対して有用な術式であると考える．

　Parastomal hernia is the most common complication following colostomy, but no standardized surgical procedure exists. Procedures that utilize mesh are recommended as they have a low recurrence rate. These procedures include the Keyhole and Sugarbaker methods performed under laparoscopy. In recent years, the Sandwich method, which combines these two methods, has been reported to have an even lower recurrence rate, making it the preferred option when possible. In the present case, we performed the Sandwich plus method by suturing and shrinking the hernia ring, followed by the Keyhole method and the Sugarbaker method using a self-made mesh, resulting in a favorable outcome. We believe that this combined procedure is a useful technique for parastomal hernia.