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

Lin, Ronggui; Lin, Xianchao; Lü, Fang; Fang, Haizong; Yang, Yuanyuan; Wang, C; Chen, Y; Huang, Heguang

doi:10.1007/s10029-018-1783-3

Cited by 8 publications

(4 citation statements)

References 28 publications

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“…Scrotal haematoma and seroma are common post-operative complications thought to result from the extensive sac separation in huge and long standing indirect inguinal hernias with reported incidence of 8–22% [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Closed non-suction drain placement as haematoma and seroma formation preventive measure post-nylon darn surgery for inguinoscrotal hernias in adults

Hagbevor

Ali

Awuku

2021

Hernia

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Purpose Inguinal hernia is a common male surgical disease. Intervention carries a wide range of complications such as scrotal haematoma and seroma which may require surgical re-intervention or predispose patients to developing infections, pains or feeling of mass. This could lead to long hospital stay. Scrotal tamponade by bandaging or wearing of tight pants and elevation are practiced to reduce bleeding and haematoma formation. These methods require prolong use. Closed suction drains are scarcely used in resource-deprived communities due to high cost and non-availability. Aim This study was to determine the effectiveness of a closed non-suction drain in preventing scrotal collection requiring further surgical intervention and the predisposition to developing surgical site infection following nylon darn repair of inguinoscrotal hernia. Methods Forty (40) participants were recruited for a preliminary study and assigned into control and interventional groups (CG, IG) for purposes of inserting flexible feeding tube (FFT) wound drain after nylon darn (ND) repair. Daily measurement of drained scrotal collection was carried out in the IG till the day drainage was zero. Residual volumes in IG and wound collection in the CG who were not candidates for re-intervention were determined at 14th and 28th post-operative days using ultrasound scan. Data were analyzed using SPSS version 25. Results Three (3) patients (15.8%) in the CG required re-intervention. Surgical site infection rates for the CG and IG were, respectively, 2/19 versus 0/21 (ρ = 0.134).There was a numerical significant difference in the mean volumes of scrotal collections between the control (0.95 ± 0.42 ml) and the intervention group (0.44 ± 0.33 ml) [p value of 0.041] but with no clinical impact. Conclusion Simple inexpensive flexible feeding tube placement significantly reduced scrotal collection which forms a base for larger sample size in subsequent studies. This could reduce the feared risk of re-intervention, wound infection and long hospital stay post-operative.

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Section: Introductionmentioning

confidence: 99%

Closed non-suction drain placement as haematoma and seroma formation preventive measure post-nylon darn surgery for inguinoscrotal hernias in adults

Hagbevor

Ali

Awuku

2021

Hernia

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“…Compared with anterior approach repair, the Kugel procedure proposed in 1999[ 1 ] can repair the entire inguinal region to strengthen the potential weakness of the myopectineal orifice, with the lower incidence of chronic pain and recurrence. [ 2 ] As our hospital performs the largest number of Kugel procedure in China and perhaps the world, we developed a modified Kugel procedure[ 3 ] through the internal ring approach on the basis of predecessors' and our experience and successfully promoted it to primary hospitals. However, the learning level of each hospital is uneven.…”

Section: Discussionmentioning

confidence: 99%

Transabdominal preperitoneal repair for a recurrent inguinal hernia after Kugel procedure using the medial umbilical ligament

Wang

Lin

et al. 2022

Journal of Minimal Access Surgery

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The Kugel procedure resulted in extensive adhesion in the preperitoneal space. Performing a transabdominal preperitoneal repair (TAPP) for recurrent hernia after Kugel procedure is extremely difficult. In this case report, we present the case of a 81-year-old male who presented with recurrent inguinal hernia after Kugel procedure 8 years ago. Transabdominal laparoscopy was performed first. Indirect hernia formed inferior to the lateral edge of the previous mesh was diagnosed under laparoscopy. The patient's medial umbilical ligament (MUL) was big enough and could be completely released by separating the Retzius space. Finally, TAPP was successfully performed by using the MUL to create and close the preperitoneal space. No perioperative complications or hernia recurrence was observed 1 year after the surgery. Using the MUL to deal with preperitoneal problems was practical and feasible.

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“…The Lichtenstein and anterior Kugel mesh repair were performed as previously described in studies [12][13][14]. It should be emphasized that try not to open the peritoneal sac during surgery.…”

Section: Operative Techniquesmentioning

confidence: 99%

Inguinal hernias in patients on continuous ambulatory peritoneal dialysis: is tension-free mesh repair feasible?

et al. 2020

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Background Continuous ambulatory peritoneal dialysis (CAPD), which often causes a common complication such as abdominal wall hernia, is a prevalent alternative therapy for end-stage renal failure patients. However, relevant studies are somewhat rare, and the peritoneal dialysis (PD) protocol during the perioperative period is still controversial. The aim of this study was to evaluate the effectiveness and perioperative management of tension-free mesh repair for inguinal hernias in CAPD patients. Methods Between January 2013 and December 2019, 18 CAPD patients with 20 inguinal hernias who underwent tension-free mesh repair were retrospectively analyzed. Data on demographics, perioperative features, the perioperative dialysis protocol and surgical complications were collected and assessed. Results All hernias were diagnosed after the start of CAPD, and the median duration from PD onset to hernia formation was 16 months (2–61 months). All patients underwent successful tension-free mesh repair, including 17 Lichtenstein and 3 anterior Kugel procedures. The median operation time was 62.5 min, and the median postoperative hospital stay was 3 days. Fifteen patients received low-exchange volumes and high-frequency exchanges from 1 to 3 days after surgery for 2 weeks with gradual resumption of the original CAPD regimen within 4 weeks. Complications included seroma (n = 2) and hematoma (n = 1). No wound or mesh infection or recurrence occurred during the follow-up period. Conclusions Tension-free mesh repair is safe and feasible for inguinal hernias in CAPD patients, The Lichtenstein mesh repair should be the first choice, and anterior Kugel repair may be considered an effective procedure. Bridging hemodialysis seems unnecessary except for emergency surgery.

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

Abstract: 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.

Cited by 8 publications

References 28 publications

Closed non-suction drain placement as haematoma and seroma formation preventive measure post-nylon darn surgery for inguinoscrotal hernias in adults

Closed non-suction drain placement as haematoma and seroma formation preventive measure post-nylon darn surgery for inguinoscrotal hernias in adults

Transabdominal preperitoneal repair for a recurrent inguinal hernia after Kugel procedure using the medial umbilical ligament

Inguinal hernias in patients on continuous ambulatory peritoneal dialysis: is tension-free mesh repair feasible?

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