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Modified Kugel herniorrhaphy using standardized dissection technique of the preperitoneal space: long-term operative
1Department of Surgery, Daisan Hospital, Jikei University School of Medicine, 4-11-1 Izumihoncho, Komae, Tokyo, 201-8601, Japan, katsuhito-s@jikei.ac.jp.
Purpose:
The aim of this study was to evaluate the outcome, with a special reference to recurrence and postoperative chronic pain, of the modified Kugel herniorrhaphy (MKH) using standardized dissection of the preperitoneal space.
Patients And Methods:
Operative results were examined based on medical records and questionnaire surveys in 340 consecutive cases of MKH performed at a single institution. The operation was performed with an original 3-stage dissection of the preperitoneal space only via the internal inguinal ring.
Results:
The mean follow-up period was 50.5 ± 24.3 months. The mean operating time was 42.2 ± 13.1 min, and by Nyhus classification, significant difference was observed between types IIIA and IIIB (39.5 ± 10.8 vs. 45.6 ± 15.6 min, P = 0.0279). Eight surgeons performed 10 or more operations, and no significant difference was found in their operating time. Thirty-one patients used additional analgesics postoperatively (9.1 %) and the length of postoperative stay was 1.2 ± 0.7 days. Seven patients (2.1 %) developed complications related to the hernia operation, but none of them required re-operation. The period required to return to normal daily activities was 3 ± 3.2 days. Questionnaire forms were returned from 77.7 % of all the patients, in which 12 patients reported chronic pain (4.7 %). Visual analog scale for patients with chronic pain scored 3.8 ± 2.4, with no patient indicating restrictions on daily life. Recurrence was observed in only one case (0.3 %).
Conclusion:
MKH using standardized dissection of the preperitoneal space is a highly reproducible procedure with acceptable rate of postoperative chronic pain and recurrence.
Insights
Modified Kugel herniorrhaphy (MKH) shows low recurrence and acceptable chronic pain rates. This standardized surgical approach is reproducible for inguinal hernia repair.
Area of Science:
- General Surgery
- Minimally Invasive Surgery
- Abdominal Wall Reconstruction
Background:
- Inguinal hernias are common surgical conditions.
- Recurrence and chronic pain are significant concerns after hernia repair.
- Standardized surgical techniques aim to improve outcomes.
Purpose of the Study:
- To evaluate the outcomes of modified Kugel herniorrhaphy (MKH).
- To assess recurrence rates after MKH.
- To determine the incidence and severity of postoperative chronic pain following MKH.
Main Methods:
- A retrospective review of 340 consecutive MKH cases.
- Standardized 3-stage preperitoneal dissection via the internal inguinal ring.
- Follow-up using medical records and questionnaire surveys.
Main Results:
- Low recurrence rate of 0.3% (1 case).
- Postoperative chronic pain reported by 4.7% of patients, with mild impact on daily life.
- Mean follow-up of 50.5 months; mean hospital stay of 1.2 days.
Conclusions:
- MKH with standardized preperitoneal dissection is a highly reproducible technique.
- The procedure demonstrates acceptable rates of postoperative chronic pain and recurrence.
- MKH offers a safe and effective option for inguinal hernia repair.
