Ohuchi Masakazu, Inaki Noriyuki, Nagakari Kunihiko, Kohama Shintaro, Sakamoto Kazuhiro, Ishizaki Yoichi
Department of Gastrointestinal Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, Japan.
Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 3-1-3 Hongou Bukyo-ku, Tokyo, Japan.
J Surg Case Rep. 2019 Jun 28;2019(6):rjz199. doi: 10.1093/jscr/rjz199. eCollection 2019 Jun.
The appropriate surgical treatment for inguinal hernia in patients with liver cirrhosis and ascites remains controversial. A 79-year-old male undergoing treatment for Child-Pugh B hepatitis C-induced liver cirrhosis and hepatocellular carcinoma complicated with bilateral inguinal hernia underwent transabdominal preperitoneal (TAPP) repair. During surgery, barbed sutures were used to facilitate appropriate peritoneal closure. His postoperative course was uneventful. Information on TAPP repair for inguinal hernia in patients with liver cirrhosis and ascites is limited. The International Guidelines for Inguinal Hernia Management recommend Lichtenstein repair for patients with ascites. TAPP repair requires peritonectomy via a posterior endoscopic approach; therefore, proper peritoneal closure is important to prevent the leakage of ascitic fluid. Herein, TAPP repair was safely and successfully completed using barbed sutures to achieve proper and strong peritoneal closure. TAPP repair using barbed sutures can be an effective treatment option for patients with liver cirrhosis and ascites.
对于肝硬化腹水患者的腹股沟疝，合适的手术治疗方法仍存在争议。一名79岁男性，因丙型肝炎致Child-Pugh B级肝硬化及肝细胞癌接受治疗，同时合并双侧腹股沟疝，接受了经腹腹膜前（TAPP）修补术。手术过程中，使用倒刺缝线以利于合适的腹膜关闭。他的术后过程顺利。关于肝硬化腹水患者腹股沟疝TAPP修补术的信息有限。《腹股沟疝治疗国际指南》推荐对腹水患者采用Lichtenstein修补术。TAPP修补术需要通过后腹腔镜入路进行腹膜切除术；因此，恰当的腹膜关闭对于防止腹水漏出很重要。在此，使用倒刺缝线安全且成功地完成了TAPP修补术，以实现恰当且牢固的腹膜关闭。使用倒刺缝线的TAPP修补术对于肝硬化腹水患者可能是一种有效的治疗选择。
