Interparietal herniaに対してTAPPで修復を行った1例

Interparietal hernia repaired by laparoscopic transabdominal preperitoneal approach : A case report

◆要旨：患者は75歳，男性．3年ほど前から右下腹部の膨隆を自覚しており，徐々に増大傾向を認めたため当院を受診した．立位で右下腹部に膨隆を認め，臥位で自然に消失した．CTでヘルニア囊は内鼠径輪から内腹斜筋と外腹斜筋の間に脱出し，大網が嵌頓していた．以上からinterparietal herniaと診断し，腹腔鏡下に手術を施行した．大網の嵌頓を整復すると術前診断通り，内腹斜筋と外腹斜筋腱膜との間にスリット状のヘルニア門を認め頭外側へ進展していた．また，外鼠径ヘルニア（L1）と内鼠径ヘルニア（M1）の合併も認めたが，同時に修復可能であった．腹腔鏡下鼠径ヘルニア修復術は特殊型のinterparietal herniaに対しても，診断と治療において有用と考えられたため報告する．

　A 75-year-old man presented with right lower abdominal swelling for about three years. The swelling was observed in the right lower abdomen in the standing position and disappeared spontaneously in the supine position. CT scan revealed that the hernia had prolapsed from the internal inguinal ring between the internal and external oblique muscles. The greater omentum was incarcerated in the hernia. Based on the physical and CT scan findings, the patient was diagnosed with interparietal hernia. Transabdominal preperitoneal approach（TAPP） was performed. Laparoscopic operation revealed that the hernia had prolapsed from the internal inguinal ring and extended between the internal and external oblique muscles. A direct inguinal hernia and an indirect inguinal hernia were also found by laparoscopy. Repaire of these hernia was performed using the same laparoscopic surgical procedure that was used for the standard TAPP. The laparoscopic approach for interparietal hernia is useful for diagnosis and treatment.