Itamoto Shingo, Fujikuni Nobuaki, Tanabe Kazuaki, Yanagawa Senichiro, Nakahara Masahiro, Noriyuki Toshio
Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami, Hiroshima, Hiroshima, 734-8530, Japan.
Surg Case Rep. 2023 Mar 20;9(1):40. doi: 10.1186/s40792-023-01621-y.
Esophageal hiatal hernia (EHH) presenting after gastrectomy for carcinoma is a type of internal hernia and very rare. There have been no published reports on the use of hand-assisted laparoscopic surgery (HALS) for the treatment of an incarcerated EHH that presented after a gastrectomy. Herein, we report a rare case of HALS performed for an incarcerated EHH presenting after a laparoscopic gastrectomy.
This case report presents the case of a 66-year-old man who underwent hernia repair for an incarcerated hernia that presented after he underwent a laparoscopic proximal gastrectomy with double-tract reconstruction for cancer in the esophagogastric junction. Emergency laparoscopic hernia repair was performed and herniation of the transverse colon into the left thoracic cavity through a hiatal defect was confirmed. Since it was difficult to return the transverse colon into the abdominal cavity using forceps, the procedure was converted to HALS and the transverse colon was pulled back into the abdominal cavity. The hernia defect was closed using a non-absorbable suture. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day.
The HALS approach provides the tactile experience of an open surgery combined with the benefits of a laparoscopic procedure such as good visualization and low invasiveness. In this case, when the transverse colon that had herniated into the left hemithorax was returned to the abdominal cavity, damage to the transverse colon was avoided by using the hand. Hence, HALS was safely performed to repair an incarcerated EHH after gastrectomy.
胃癌切除术后出现的食管裂孔疝（EHH）是一种内疝，非常罕见。关于使用手辅助腹腔镜手术（HALS）治疗胃癌切除术后出现的绞窄性EHH，目前尚无公开报道。在此，我们报告一例罕见的腹腔镜胃癌切除术后出现绞窄性EHH并采用HALS治疗的病例。
本病例报告介绍了一名66岁男性的情况，该患者因食管胃交界部癌接受腹腔镜近端胃切除术并双通路重建后出现绞窄性疝，接受了疝修补术。进行了急诊腹腔镜疝修补术，证实横结肠通过裂孔缺损疝入左胸腔。由于使用钳子难以将横结肠回纳至腹腔，手术转为HALS，将横结肠拉回腹腔。使用不可吸收缝线关闭疝缺损。术后过程顺利，患者术后第4天出院。
HALS方法提供了开放手术的触觉体验，同时兼具腹腔镜手术的优点，如良好的视野和低侵袭性。在本病例中，当疝入左半胸的横结肠回纳至腹腔时，通过手部操作避免了横结肠的损伤。因此，成功地采用HALS修复了胃癌切除术后的绞窄性EHH。
