A 12-year experience of using the Kugel procedure for adult inguinal hernias via the internal ring approach
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.
KeywordsInguinal 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).
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.
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.
For this type of study formal consent is not required.
- 4.Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403. https://doi.org/10.1007/s10029-009-0529-7 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Sajid MS, Craciunas L, Singh KK, Sains P, Baig MK (2013) Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials. Gastroenterol Rep (Oxf) 1(2):127–137. https://doi.org/10.1093/gastro/got002 CrossRefGoogle Scholar
- 21.Ergul Z, Akinci M, Yilmaz KB, Sahin A, Seker G, Kulacoglu H (2011) Why do we use drains in some inguinal hernia repairs? Chirurgia (Bucur) 106(6):769–774Google Scholar
- 22.Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, Fortelny R, Heikkinen T, Jorgensen LN, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Simons MP (2014) Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 18(2):151–163. https://doi.org/10.1007/s10029-014-1236-6 CrossRefPubMedGoogle Scholar
- 24.Yasuda T, Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Kawano Y, Sekiguchi K, Ando F, Matsutani T, Uchida E (2017) Life-threatening hemorrhage from the corona mortis after laparoscopic inguinal hernia repair: report of a case. Asian J Endosc Surg. https://doi.org/10.1111/ases.12416 CrossRefPubMedGoogle Scholar
- 28.Maillart JF, Vantournhoudt P, Piret-Gerard G, Farghadani H, Mauel E (2011) Transinguinal preperitoneal groin hernia repair using a preperitoneal mesh preformed with a permanent memory ring: a good alternative to Lichtenstein’s technique. Hernia 15(3):289–295. https://doi.org/10.1007/s10029-010-0778-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Jeroukhimov I, Wiser I, Karasic E, Nesterenko V, Poluksht N, Lavy R, Halevy A (2014) Reduced postoperative chronic pain after tension-free inguinal hernia repair using absorbable sutures: a single-blind randomized clinical trial. J Am Coll Surg 218(1):102–107. https://doi.org/10.1016/j.jamcollsurg.2013.09.010 CrossRefPubMedGoogle Scholar