肥満患者における全腹腔鏡下子宮全摘術およびホルモン補充療法後に臍部異常瘢痕を合併した一例

抄録

　Rapid and better wound healing is an advantage of the laparoscopic approach compared with open surgery. The umbilicus is a preferred site for port placement considering safety and favorable cosmetic outcomes; however, postoperative management may be challenging owing to hypertrophic umbilical scars and keloids (abnormal scars).

　We report a case of abnormal umbilical scarring after total laparoscopic hysterectomy and estrogen replacement therapy (ERT) in a patient with obesity. A 46-year-old woman (body mass index 39.7 kg/m²) underwent surgery for uterine leiomyoma for management of hypermenorrhea. She experienced hot flashes 4 months later, and we initiated ERT. She presented with abnormal umbilical scarring that caused recurrent infections 26 months postoperatively, and underwent scar excision and umbilicoplasty. The patient is recurrence-free 17 months postoperatively. Obesity may have been a risk factor for abnormal scarring in this patient who received ERT. No study has reported an association between ERT and abnormal scarring; further studies are warranted to validate these findings.

　Owing to the widespread popularity of laparoscopic surgery, the number of patients with postoperative abnormal umbilical scarring is expected to increase. Abnormal scarring is attributable to chronic inflammation; therefore, it is important to reduce scar tension and maintain scar hygiene to prevent infections. Knowledge of risk factors can aid with prevention of abnormal scarring and enable prompt treatment. Individualization of port placement is important; umbilical port placement should be avoided in women with high aesthetic sensitivity for the umbilicus or in those with risk factors for abnormal umbilical scarring, such as obesity.