, Volume 22, Issue 5, pp 863–870 | Cite as

A 12-year experience of using the Kugel procedure for adult inguinal hernias via the internal ring approach

  • R. Lin
  • X. Lin
  • F. Lu
  • H. Fang
  • Y. Yang
  • C. Wang
  • Y. Chen
  • H. Huang
Original Article



Kugel procedure is a classic preperitoneal herniorrhaphy via the posterior approach for inguinal hernias but it has a steep learning curve. The aim of the study is to evaluate the efficacy of the Kugel procedure via the internal ring approach.


Kugel procedures via the internal ring approach were performed on 3673 patients with inguinal hernias between September, 2005 and August, 2017. Demographic data, peri-operative data and postoperative data were collected to evaluate of the efficacy of this technique.


None of the patients with inguinal hernias who underwent the Kugel procedure via the internal ring approach was converted to other procedures. The mean operation time for a unilateral hernia was 46.3 ± 15.2 min, with a mean blood loss of 28.9 ± 10.5 mL. The mean visual analogue scale score on postoperative day 1 was 3.1 ± 0.9. Drainage tubes were placed in 266 patients and were removed after a mean duration of 2.8 ± 0.5 days. The mean postoperative hospital stay was 1.2 ± 0.8 days. There were no serious intra-operative complications. Postoperative complications included seroma (n = 84), haematoma (n = 28), ecchymosis (n = 33), superficial incision infection (n = 1), recurrence (n = 1) and mild chronic pain (n = 11).


The Kugel procedure via the internal ring approach is a safe, feasible and cost-effective technique for inguinal hernias that retains the benefits of the standard Kugel procedure and is easier to master.


Inguinal hernia Tension-free Open repair Complication Approach 



The study was supported by Medical Minimally Invasive Center Program of Fujian Province, China (no. 2017-171), Key Clinical Specialty Discipline Construction Program of Fujian Province, China (no. 2012-649).

Author contributions

RL and HH conceived and designed the study, and checked and revised the whole manuscript. XL, FL, HF and YY collected the data, CW and YC analyzed the data. RL wrote the manuscript. All authors read and approved the manuscript.

Compliance with ethical standards

Conflict of interest

RL, XL, FL, HF, YY, CW, YC, HH declares no conflict of interest.

Ethical approval

Approval from the institutional review board was not required for this study.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • R. Lin
    • 1
  • X. Lin
    • 1
  • F. Lu
    • 1
  • H. Fang
    • 1
  • Y. Yang
    • 1
  • C. Wang
    • 1
  • Y. Chen
    • 1
  • H. Huang
    • 1
  1. 1.Department of General SurgeryFujian Medical University Union HospitalFuzhouPeople’s Republic of China

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