Treatment outcomes of Kugel repair for obturator hernias: a retrospective study.

BACKGROUND: We examined the validity and applicability of the Kugel repair approach for obturator hernias, whereby we placed a Kugel patch through the preperitoneal space after placing a short 5-cm skin incision just medial to the anterior iliac spine and 2 cm cranial to the expected origin of the internal inguinal ring. METHODS: We studied patients who underwent surgical Kugel repair for obturator hernias at the Department of General Surgery, Saitama Medical University between 2007 and 2017. We examined the operating time, length of hospital stay, postoperative complications, and mortality rate. RESULTS: Fifty-eight patients with obturator hernias presented with symptoms of small bowel obstruction. A Kugel approach was used in 53 patients and a midline approach was used in 5 patients with preoperative peritonitis. Of the 53 patients managed using the Kugel approach, 39 did not require intestinal resection; a mesh was used in all these patients. In the remaining 14 patients, intestinal resection was required and performed using the same approach; subsequently, a mesh was used successfully in 6 of these 14 patients. The overall median operating time was 47 min; the corresponding values for procedures with and without intestinal resection were 39 and 68 min, respectively. In terms of postoperative complications, operative mortality was not noted among patients without intestinal perforation; however, superficial surgical site infection developed in 2 patients. Among the 5 patients with preoperative peritonitis who underwent exploratory laparotomy via a midline incision, intestinal perforation was detected during surgery, and all patients required intestinal resection; none of the patients had received a mesh, and 2 patients died after surgery. CONCLUSIONS: The Kugel repair approach was possible even in patients with obturator hernia requiring intestinal resection. However, for patients with perforations, open surgery should be performed after securing the surgical field through a midline incision.

Clinical research of tension-free herniorrhaphy using Kugel patch in 355 inguinal hernias / 国际外科学杂志

Objective To explore the clinical effects of Kugel surgical treatment for inguinal hernia.Methods Operative time,chornic pain,complications and charges of 355 patients with inguinal hernias were analyzed retrospectively.Results Recurrences occurred in 1 patient,during a mean followl-up of 36 months (range:7-85).The average operation time was 35.4 min (range:20-130),average surgical charges were 6 253 yuan.Postoperaive chronic pain appeared in 6 patients.There are 3 cases of sermoa,1 case of haematoma and 2 case of wound infection.Conclusion The Kugel inguinal hernia repair is safe and effective,with the advantage of mild pain and prompt recovery after operation,and a low risk of complications and recurrence.