Abstract
Purpose
We report our results with the modified Kugel hernia repair, a relatively new and minimally invasive open technique offering the advantages of preperitoneal repair without the need for general anesthesia.
Methods
We performed 42 inguinal or femoral hernias (44 sides), including incarcerated femoral hernias, using this modified technique, giving the patient local anesthesia with very little sedation. We describe the operative techniques used and the postoperative complications encountered.
Results
The mean operation time was 55 ± 26 min and the mean hospital stay was 4 days (2–8 days). There were no major postoperative complications and patients were followed up for a mean period of 1 year. Only one patient complained of mild discomfort in the inguinal area after 6 months. There was no incidence of recurrence.
Conclusion
The modified Kugel hernia repair is easy to learn, and it seems to have a lower recurrence rate and fewer postoperative complications than conventional types of hernia repair. Moreover, it offers the advantage of allowing the patient to undergo preperitoneal inguinal hernia repair under local anesthesia, which is especially beneficial for older patients with preoperative morbidity.
Similar content being viewed by others
References
Simons MP, Kleijnen J, Van Geldere D, Hoitsma HF, Obertop H. Role of the Shouldice technique in inguinal hernia repair: a systematic review of controlled trials and a meta-analysis. Br J Surg 1996;83(6):734–738.
Amid PK. Groin hernia repair: open techniques. World J Surg 2005;29(8):1046–1051.
Amid PK, Shulman AG, Lichtenstein IL. The Lichtenstein open “tension-free” mesh repair of inguinal hernias. Surg Today 1995;25:619–625.
Amid PK. The Lichtenstein repair in 2002: an overview of causes of recurrence after Lichtenstein tension-free hernioplasty. Hernia 2003;7:13–16.
Voyles CR, Hamilton BJ, Johnson WD, Kano N. Metaanalysis of laparoscopic inguinal hernia trials favours open hernia repair with preperitoneal mesh prosthesis. Am J Surg 2002;184(1):6–10.
Neumayer L, Giobble-hurder A, Jonasson O, Fitzgibbons R, Dunlop D, Gibbs J, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004;350(18):1819–1827.
Kugel RD. The Kugel repair for groin hernias. Surg Clin North Am 2003;83(5):1119–1139.
Rutkow IM. The recurrence rate in hernia surgery: how important is it? Arch Surg 1995;130:575–576.
Dogru O, Girgin M, Bulbuller N, Cetinkaya Z, Aygen E, Camci C. Comparison of Kugel and Lichtenstein operations for inguinal hernia repair: results of a prospective randomized study. World J Surg 2006;30(3):346–350.
Ceriani V, Faleschini E, Bignami P, Lodi T, Roncaglia O, Osio C, et al. Kugel hernia repair: open “mini-invasive” technique. Personal experience on 620 patients. Hernia 2005;9(4):344–347.
Van Nieuwenhove Y, Vansteenkiste F, Vierendeels T, Coenye K. Open, preperitoneal hernia repair with the Kugel patch: a prospective, multicentre study of 450 repairs. Hernia 2007;11(1):9–13.
Schroder DM, Lloyd LR, Boccaccio JE, Wesen CA. Inguinal hernia recurrence following preperitoneal Kugel patch repair. Am Surg 2004;70(2):132–136.
Hoste W, Van Nieuwenhove Y, Vierendeels T. Early Belgian experience with the Kugel patch inguinal hernia repair. Acta Chir Belg 2006;106(1):44–46.
Ceriani V, Faleschini E, Sarli D, Lodi T, Roncaglia O, Bignami P, et al. Femoral hernia repair Kugel retroparietal approach versus plug alloplasty: a prospective study. Hernia 2006;10(2):169–174.
McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, et al. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 2005;9:1–203, iii–iv.
Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 2003;90:1479–1492.
Stylopoulos N, Gazelle GS, Rattner DW. A cost-utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients. Surg Endosc 2003;17:180–189.
Kugel RD. Minimally invasive, non-laparoscopic, preperitoneal, and sutureless, inguinal herniorrhaphy. Am J Surg 1999;178:298–302.
Nordin P, Zetterstrom H, Gunnarsson U, Nilsson E. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet 2003;362:853–858.
Amid PK, Shulman AG, Lichtenstein IL. Local anesthesia for inguinal hernia repair step by step procedure. Ann Surg 1994;220:735–737.
Misawa T, Sakurai M, Kanai H, Matsushima M, Yamazaki Y, Yanaga K. Kugel herniorrhaphy: clinical results of 124 consecutive operations. Surg Today 2005;35:639–644.
Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA. Cooperative hernia study. Pain in the postrepair patient. Ann Surg 1996;224:598–602.
Author information
Authors and Affiliations
Additional information
An erratum to this article is available at http://dx.doi.org/10.1007/s00595-008-3889-1.
Rights and permissions
About this article
Cite this article
Li, J., Zhang, Y., Hu, H. et al. Early experience of performing a modified Kugel hernia repair with local anesthesia. Surg Today 38, 603–608 (2008). https://doi.org/10.1007/s00595-007-3681-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-007-3681-7