膨潤麻酔併用単孔式TEP法を行ったTAPP法術後再発鼠径ヘルニアの1例  [in Japanese] A Case of Single-incision Totally Extraperitoneal Repair Using Tumescent Anesthesia for Recurrence of Inguinal Hernia after Transabdominal Preperitoneal Repair  [in Japanese]

Access this Article

Author(s)

Abstract

腹腔鏡下手術を含む腹膜前腔を剥離する鼠径ヘルニア術後再発症例の手術は,初回手術の剥離範囲とメッシュを覆う瘢痕組織の剥離が困難であるケースが多い.今回15年前に施行されたTAPP法術後の再発症例を単孔式TEP法により修復できたので報告する.TAPP法は外側の内鼠径輪周囲の剥離に優れ,対してTEP法は内側の膀胱上・Hesselbach3角周囲の剥離が容易といったアプローチ経路の違いに起因する操作の優位性の違いがあると考えられている.そのため,今回内側の癒着を認める再発症例に対して,臍輪から腹腔内観察・膨潤麻酔の内鼠径輪周囲局注・減圧チューブ挿入という3点の工夫を加えることにより,TEP法の優位性を生かし安全に単孔式にてTEP法を完遂した.これらの工夫は,本症例のような再発症例に対して安全に単孔TEP法を遂行する上で簡単であるが重要な工夫であると考えた.

During reoperation after laparoscopic surgery which involved dissection of the preperitoneal space for an inguinal hernia, it is often difficult to remove adhesions covering mesh and healed tissue. We report a case in which we treated a recurrent hernia after transabdominal preperitoneal (TAPP) repair performed 15 years earlier, using single-incision totally extraperitoneal (TEP) technique rather than TAPP technique. The TAPP technique is superior for dissection of the lateral preperitoneal space around the internal inguinal ring ; conversely, the TEP technique is superior for dissection of medial preperitoneal space around the bladder and Hesselbach's triangle. It is generally thought that the ease of performing these techniques differs depending on the preceding surgery. Therefore, we performed single-incision TEP for a recurrent hernia complicated by adhesions involving medial tissues by adopting three measures : careful inspection of the abdominal cavity, use of tumescent anesthesia in the preperitoneal space around the inner inguinal ring, and insertion of a drainage tube. These are simple but important measures to ensure safe completion of single-incision TEP for recurrent hernia, as in the present case.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 78(10), 2347-2351, 2017

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130006728976
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • NDL Article ID
    028625929
  • NDL Call No.
    Z19-227
  • Data Source
    NDL  J-STAGE 
Page Top