Minimally Invasive Preperitoneal Hernioplasty (Kugel Procedure) In Inguinal Hernia Repair

Objective :To evaluate the clinical application of Kugel hernioplasty in inguinal hernia repair.Methods:A retrospective study were made to analyze the clinical data of 385 cases treated with Kugel hernioplasty of inguinal hernias from November 2004 to December 2008.Results: 385 cases (420 hernias in total) were included in this study.The numbers of male and female were 347 and 38 respectively,mean age (60.90±16.24)years,mean BMI (22.95±2.76)kg/㎡ ,mean clinical course(55.19±11.76)months.In the series,Direct/indirect/femoral/co-existence hernias were 46/329/7/3 (including 35 recurrent hernias),incarcerated/strangulated hernias were 17/2,typeⅠ/Ⅱ/Ⅲ/Ⅳwere 42/211/132/32.Mean operative duration was (52.17±25.56)mins.Negative pressure draining tubes were placed in 39 hernias. Mean placement time was (6.54±1.02)days. Mean postoperative stay was (3.51±1.30) days. 57.9%(223/385) of these cases stayed for 1 or 2 days.Mean follow-up was (25.2±2.3)months.The follow-up rate reached 91%(351/385).Postoperative complications such as acute urinary retention (n =14,3.64%),seroma (n=7,1.82%),hematoma (n=2,0.05%),sub dermal ecchymosis (n= 3,0.78%),chronic groin pain (n = 27,7.69%),abdominal discomfort (n =22,6.23%),skin paresthesia (n=16,.56%)and recurrence (n = 3,0.78%) were observed.Other complications such as infection,ischemic orchitis,testis atrophy,ejaculatory pain never happened.Sexual function of 14 cases among 243 male patients was worse than preoperation,psychological factors may responsible for this phenomenon.19 cases had an improvement in sexual quality postoperatively.7 male patients proved to keep the reproductive ability postoperatively during the follow-up period.Conclusion Kugel hernioplasty can repair and strengthen the whole anatomy area of myopectineal orifice. It is available for various kinds of inguinal hernias, especially for complex hernias, elderly hernias and recurrent hernias. Advantages of this procedure also including minimal invasion, rapid recovery, less postoperative complication and no side-effect to postoperative sexual function .