第7巻 2011年6月　第3号

■臨床医のために

巨大食道裂孔ヘルニアに対する腹腔鏡下手術
野村　務¹, 宮下　正夫¹, 牧野　浩司¹, 萩原　信敏¹, 赤城　一郎¹, 塩田　吉宣¹, 加藤　俊二¹, 藤田　逸郎¹, 岩切　勝彦², 内田　英二^1
1日本医科大学大学院医学研究科臓器病態制御外科学
²日本医科大学大学院医学研究科病態制御腫瘍内科学

Laparoscopic Operation for Giant Hiatal Hernia
Tsutomu Nomura¹, Masao Miyashita¹, Hiroshi Makino¹, Nobutoshi Hagiwara¹, Ichiro Akagi¹, Yoshinobu Shioda¹, Shunji Kato¹, Itsuro Fujita¹, Katsuhiko Iwakiri² and Eiji Uchida^1
1Department of Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
²Department of Pathophysiological Management/Medical Oncology, Graduate School of Medicine, Nippon Medical School

Type III hiatal hernia (giant hiatal hernia) is a mixture of type I (sliding hernia) and type II (paraesophageal hernia) hiatal hernias and sometimes causes severe complications if stomach necrosis has occurred. Therefore, surgical treatment is recommended. We discuss the available treatments for type III hiatal hernia and describe our procedure for laparoscopic antireflux surgery. We performed Nissen or Toupet fundoplication, depending on the esophageal function of each patient. Crural repair should be performed with calibration using a 56-Fr bougie to avoid postoperative dysphagia. As much as possible of the hernia sac should be removed to prevent hernia recurrence. Some authors have reported that laparoscopic antireflux surgery for type III hiatal hernia is a technically challenging and controversial procedure. However, the outcomes at our hospital have been excellent, and the level of patient satisfaction has been high.

日医大医会誌 2011; 7(3), 119-123

Key words
giant hiatal hernia, laparoscopic operation

Correspondence to
Tsutomu Nomura, Department of Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan
E-mail：nomura-t@nms.ac.jp

受付：2011年3月7日　受理：2011年4月5日