腹腔鏡下にストーマ傍ヘルニア（双孔式結腸ストーマ）修復術を施行した1例

DOI Web Site 参考文献10件
  • 野中 隆
    独立行政法人国立病院機構長崎医療センター外科
  • 永田 康浩
    独立行政法人国立病院機構長崎医療センター外科

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  • A Case of Laparoscopic Repair for Parastomal Hernia (Loop Colostomy)

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The author presents the case of a 76-year-old woman who had undergone double-barrel sigmoid colostomy for rectovesical fistula 4 years earlier. The patient presented with mild obesity and had been taking an oral steroid for a long time. Parastomal hernia had recently been noted and she presented with aggravated ileus symptoms and was experiencing difficulty in controlling the stoma, so laparoscopic hernioplasty was performed. A hernial orifice with major and minor axes of 10cm and 5 cm, respectively, was observed inside an elevated colon. A patch of ParietexTM Parastomal Mesh was wrapped around the elevated colon such that it was located in the center of the keyhole-shaped precut hole of the patch. Then the hernial orifice was covered by the ParietexTM Parastomal Mesh and was fixed using a tacker. In addition, we reinforced the site of the central part of the keyhole by fixing the pedunculated greater omentum to the elevated colon with sutures in such a manner that the greater omentum was wound around the elevated colon. The postoperative clinical course was favorable and the patient was discharged from hospital on the sixth day after the surgery. At the time of reporting, one year after the surgery, no relapse of hernia was observed in the patient. Thus, laparoscopic hernioplasty using mesh is considered beneficial for patients who are at high risk of infection, including those with obesity or diabetes mellitus, or patients who are receiving any oral steroid.

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