Comment to: A 12-year experience of using the Kugel procedure for adult inguinal hernias via the internal ring approach. Lin R, Lin X, Lu F et al. Hernia 2018;22:863–870
I read with interest the article by Lin et al. on a modification of the Kugel procedure . Lin et al. have a huge experience with this method and yielded good results. Nevertheless, I would point out that the technique they used has been described earlier and it is named the TIPP technique (Trans Inguinal Pre Peritoneal). In fact, they did not perform a modified “Kugel procedure”, as announced in the title, but a TIPP with the Kugel patch.
Contrary to what the authors believe, the technique I described in 2006  is not a modification of the Kugel procedure. The concept on which the TIPP was based is the same as the technique described by Lin et al. in their article. It consists of using the hernia orifice to carry out preperitoneal dissection, introduction and deployment of the patch, without any damage to the abdominal wall—neither long incision with extended dissection, nor trocar holes.
My initial article clearly stated that the patch was placed via the hernia orifice using a short incision, even though the drawings showed an extended dissection to clearly demonstrate this new concept .
This technique evolved with time. At the beginning, the lateral part of the patch was split and both tails surrounded the spermatic cord. Splitting the patch was abandoned later on, and the method was switched to the current TIPP with cord parietalization [3, 4, 5, 6].
To perform this technique, I conceived and patented a memory-ring patch whose shape was different from the Kugel patch, adapted to anatomy of the inguinal area. This patch was manufactured and marketed by Bard under the name Polysoft. The design of the Polysoft patch is different from the design of the Kugel patch and protected by different patents. Today the Polysoft patch has been replaced by the Onflex patch, which is equipped with an absorbable memory-ring.
Compliance with ethical standards
Conflict of interest
Dr Pélissier has a patent agreement with Bard Davol
Ethical approval was not required for this article.
Human and animal rights
This article does not contain any study with human participants or animals.
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