A randomized clinical study on postoperative pain comparing the Polysoft patch to the modified Kugel patch for transinguinal preperitoneal inguinal hernia repair.

PURPOSE: The transinguinal preperitoneal approach is a relatively new technique for inguinal hernia repair. Two types of memory-ring mesh are available in Japan: the modified Kugel patch (MK) and the Polysoft patch (PP). We tested the hypothesis that the PP is noninferior to the MK with respect to chronic postoperative pain. METHODS: An unblinded randomized controlled trial was conducted to assess the noninferiority of PP compared to MK with a 5 % noninferiority margin. A total of 442 inguinal hernia patients operated on from November 2010 to December 2012 were included in this study. The primary endpoint was the pain score assessed by the visual analog scale (VAS) (0-1 vs. 2-10) 1 year after surgery. RESULTS: The patients were randomized to the PP and MK groups (n = 221 each). One year after surgery, 206 patients (95.4 %) in the PP group and 182 patients (89.6 %) in the MK group rated pain at 0-1 on the VAS scale. According to this rating, the PP group appeared not to be inferior to the MK group (95 % confidence interval, 0.7-10.7 %, P < 0.05). Furthermore, crude superiority tests, adjusting for 1 month of pain, denoted that the outcomes were significantly improved with the PP compared to the MK. CONCLUSIONS: The use of the PP was noninferior to the MK with respect to the severity of postoperative chronic pain scores 12 months after surgery.

Long-term follow-up of anterior approach preperitoneal hernia repair using the Kugel patch.

BACKGROUND: Despite many advantages of original Kugel hernia repair over other procedures, there exist certain disadvantages of technical difficulty, long learning curve, and high early recurrence. The aim of this study was to explore the outcomes of long-term follow-up using anterior approach preperitoneal hernia repair with the Kugel patch and determine its safety and efficacy. METHODS: Five hundred eighty-one inguinal hernias were performed in 560 patients, using anterior approach preperitoneal repair. Patients' age and sex, type of hernias, operative time, hospital stay, complications, and recurrence were evaluated. RESULTS: We included 581 hernias, with 354 on right side, 162 on left side, and 65 bilateral sides. All hernias were primary. There were 443 indirect hernias, 115 direct hernias, and 23 femoral hernias. Mean operative time was 50 minutes; local anesthesia was applied in 530 cases (91.2%). Postoperative complications affected 50 patients (8.9%). The patients were discharged from 4 to 8 days (with average of 6 days). The averaged follow-up time was 70 months (12 to 120 months). There were 3 recurrences in the period (.5%). CONCLUSIONS: The results of long-term follow-up with this procedure are safe and effective, easy to learn. We believe that this procedure should be adopted as an alternative method for Chinese patients with inguinal hernias.