Abstract
Compared with the conventional anterior approach, the Kugel method that is the posterior approach has such an aspect as has not widely used as yet, because it is difficult for us to get anatomical understanding and to reach the correct preperitoneal stratum disjunctum. In the original Kugel method, the inferior epigastric artery and vein are defined as the first indicator to identify the preperitoneal space, and parietalization is started from the center side to the outer side ; we call it as “center side approach” in this paper. In our method, however, without being conscious of the inferior epigastric artery and vein and by seeing the deep preperitoneal fascia and preperitoneal fat to be indicators, the parietalization is started from the outer side to the center side ; we call it as “lateral approach”. With this method, we are able to reach the correct stratum disjunctum far easier than the conventional method. As a result, the operating time significantly shortened from 43 minutes by the center side approach (n=1,093) to 33 minutes by the lateral approach (n=1,316), and the recurrence rate also decreased from 1.2% to 0.2%, respectively.
