Fujimoto Mutsumi, Miguchi Masashi, Mitsuta Hiroshi, Ikeda Satoshi, Nakahara Hideki, Itamoto Toshiyuki
Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan.
Department of Surgery, Otagawa Hospital, 1-21-25 Hesakasenzoku, Higashi-ku, Hiroshima, Japan.
Surg Case Rep. 2022 Jan 11;8(1):9. doi: 10.1186/s40792-022-01362-4.
Sciatic hernias are rare pelvic floor hernias that occur through the sciatic foramen and often present as abdominal or pelvic pain, particularly in women. Historically, they were repaired using an open approach, with limited reports on their laparoscopic treatment.
Here we present the case of an 85-year-old woman who had repeated abdominal pain and was referred to our hospital for sciatic hernia surgery after conservative treatment. We laparoscopically observed the deep pelvis and identified the right sciatic hernia. When an extraperitoneal space was dissected, an ureterohypogastric nerve fascia (UNF) and a vesicohypogastric fascia (VF) were identified. Moreover, the maneuver to mobilize the fasciae inside from the pelvic wall made it possible to separate the ureter and urinary bladder, which might have otherwise incarcerated in the hernia. We repaired the defect of the sciatic foramen with a mesh plug and patch. The patient had an uneventful recovery, and the absence of sciatic herniation recurrence was confirmed 1 year after surgery.
A laparoscopic repair of a sciatic hernia could permit detailed non-invasive observations of the deep pelvis and be performed effectively by recognizing an UNF and a VF located near the sciatic foramen.
坐骨疝是一种罕见的盆底疝，通过坐骨大孔突出，常表现为腹部或盆腔疼痛，在女性中尤为常见。历史上，其修复采用开放手术方式，关于腹腔镜治疗的报道有限。
我们在此报告一例85岁女性患者，反复出现腹痛，经保守治疗后转诊至我院行坐骨疝手术。我们通过腹腔镜观察盆腔深部，发现右侧坐骨疝。在分离腹膜外间隙时，识别出输尿管下腹神经筋膜（UNF）和膀胱下腹筋膜（VF）。此外，从盆腔壁向内游离筋膜的操作使得分离输尿管和膀胱成为可能，否则它们可能会被疝入物卡住。我们用网塞和补片修复了坐骨大孔的缺损。患者恢复顺利，术后1年证实无坐骨疝复发。
腹腔镜修复坐骨疝可对盆腔深部进行详细的非侵入性观察，并通过识别坐骨大孔附近的UNF和VF有效实施手术。
