女児鼠径ヘルニアにおけるsimple herniorrhaphy(従来法)と腹腔鏡下経皮的腹膜外ヘルニア閉鎖術(LPEC法)の後方視的比較検討

原著
背景: 小児鼠径ヘルニアの根治術にはsimple herniorrhaphy(従来法)と腹腔鏡下経皮的腹膜外ヘルニア閉鎖術(LPEC法)がある.我々は2014年8月より1歳以上の女児例に対しLPEC法を行っている.対象と方法: 2010年8月から2018年7月の女児鼠径ヘルニア,従来法150例(164側),LPEC法95例(103側)を後方視的に比較検討した.結果: 手術時間は片側・両側ともLPEC法で有意に長かった.術者ごとのLPEC法の手術時間に有意差はなかった.LPEC法での対側腹膜鞘状突起開存率は46.0%で,全例を閉鎖し有意に術後対側発症が減少した.創感染,疼痛症状,再発率に有意差はなかった.LPEC法の12.6%に臍の変形を認めた.結論: LPEC法は従来法と同等の手術成績を有する.術後対側発症の予防が見込めるが,手術時間の延長,臍の変形を及ぼす可能性があることが特徴である.Introduction: In the treatment of inguinal hernia (IH), both simple herniorrhaphy (SH) and laparoscopic percutaneous extraperitoneal closure (LPEC) are standard procedures. We adopted LPEC in the case of girls over 1 year old since August 2014. Methods: The subjects were pediatric IH patients from August 2010 to July 2018 in our department. Of these, 150 patients (164 sides) underwent SH and 95 patients (103 preoperative sides) underwent LPEC. Results: Regardless of unilateral or bilateral, the operative time in LPEC was significantly longer than that in SH. The operative time of LPEC was similar among surgeons. In LPEC, 46.0% of unilateral IH patients showed positive contralateral patent processus vaginalis (PPV), and we performed preventive ligation for all positive PPV. Although the occurrence of postoperative contralateral hernia was detected in 6.3% of unilateral IH in SH, it was not recognized in LPEC. The incidence rates of surgical site infection, postoperative pain, and recurrence were similar in the two groups. However, 12.6% patients in LPEC complained regarding the minor deformity at the umbilicus after surgery. Conclusion: LPEC can prevent postoperative contralateral hernia due to the ligation of contralateral PPV. However, the operative time in LPEC was longer than that in SH. In addition, LPEC can lead to the deformation of umbilicus in some of patients. Although there are some differences like these, LPEC is as safe and efficacious as SH for IH in girls.