■臨床医のために
腹壁瘢痕ヘルニアに対するメッシュを用いた腹腔鏡下手術
野村 務, 松谷 毅, 萩原 信敏, 藤田 逸郎, 金沢 義一, 中村 慶春, 進士 誠一, 古木 裕康, 増田 寛喜, 内田 英二
日本医科大学消化器外科学
Laparoscopic Incisional Hernia Repair with Mesh
Tsutomu Nomura, Takeshi Matsutani, Nobutoshi Hagiwara, Itsuro Fujita, Yoshikazu Kanazawa, Yoshiharu Nakamura, Seiichi Shinji, Hiroyasu Furuki, Hiroki Masuda and Eiji Uchida
Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School
Laparoscopic incisional hernia repair with mesh is widely performed in Western countries as a treatment that is considered more reliable than conventional open repair. However, this procedure is not common in Japan. We report our experiences with this procedure using a new type of mesh (Ventralight ST TM, Medicon, Osaka, Japan).
This procedure is indicated for almost all patients with incisional hernia but was difficult to perform for patients with giant hernia of the flank after nephrectomy. The procedure is performed with the patient in the supine position and 4 or 5 ports. One port is a 12-mm port, and the others are 5-mm ports. First, the 12-mm port is inserted in the left hypochondrium by the optical method. After pneumoperitoneum is established, we observe the abdominal cavity with a 5-mm flexible endoscope and insert the other ports, while dissecting peritoneal adhesions as necessary. We measure the hernia and trim the mesh to secure at least a 3-cm overlap with the normal abdominal wall. We insert the mesh through the 12-mm port, lift it to make tight contact with the abdominal wall by means of a transfixed thread, and fix the mesh with spiral tackers.
We have performed this procedure for 14 patients. The mean operative duration was 127 minutes, and the average postoperative hospital stay was 5.9 days. There were no complications except for seroma, and the patient satisfaction was extremely high. In conclusion, laparoscopic incisional hernia repair with mesh is a useful and promising treatment that will, we believe, be introduced in many institutions in Japan.
日医大医会誌 2015; 11(1), 16-19
Key words
incisional ventral hernia, laparoscopic repair, Ventralight STTM mesh
Correspondence to
Tsutomu Nomura, Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
E-mail：nomura-t@nms.ac.jp
受付：2014年9月17日 受理：2014年11月17日 |
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