Abstract
Kugel repair refers to the use of the open transinguinal preperitoneal approach with preperitoneal self-expanding mesh. From January 2003 to December 2014, 2363 patients (2594 lesions) with inguinal hernias underwent Kugel repair. The mean operation time was 23 ± 13 min (median 20 min) and the operation time in patients with recurrent hernias (n = 133, 41 ± 29 min) was significantly longer than that in patients with primary hernias (n = 2461, 22 ± 11 min, p < 0.001). Overall, 20 patients (0.8%) relapsed after Kugel repair. With respect to complications, intraoperative urinary bladder injury occurred in five cases, massive bleeding in one case, postoperative intestinal obstruction in one case, mesh infection in one case, and chronic neuralgia in one case. Four of five cases with urinary bladder injury and one case with postoperative intestinal obstruction were patients with recurrent hernias after preperitoneal prosthetic repairs. Using preperitoneal self-expanding mesh, Kugel repair can cover the entire myopectineal orifice. All types of primary inguinal hernias and recurrent hernias after conventional and Lichtenstein repairs can feasibly be treated by Kugel repair. However, patients with previous preperitoneal prosthetic hernia repairs or a history of prostate cancer surgery should avoid Kugel repair because of the risk of complications due to preperitoneal adhesions.
