title: Kugel herniorrhaphy: clinical results of 124 consecutive operations.
abstract: OBJECTIVE
  Due to its recent clinical application, the results of Kugel herniorrhaphy have not yet been well documented. We analyzed our experience in performing 124 consecutive Kugel herniorrhaphies at a single institute.
  
  
  METHODS
  Since the first introduction of Kugel herniorrhaphy in Japan in September 2001, a total of 117 patients (124 hernias) have undergone this procedure at our institute. The operative technique of Kugel herniorrhaphy was directly obtained through two hands-on training courses that were given by Dr. Kugel. The clinical results of the 124 hernias were analyzed, and to understand the feasibility of performing Kugel herniorrhaphy for various types of hernias, the operation time and the necessity for dividing the hernia sac were compared among each type based on the Nyhus classification.
  
  
  RESULTS
  The operation times in types 2, 3A, 3B, 3C, and 4 were 48.5 +/- 19.5, 45.9 +/- 19.9, 54.2 +/- 24.8, 52.5 +/- 10.6, and 64.4 +/- 56.7 min, respectively, and the differences between each group were not statistically significant. In type 3A, no patient required a division of the hernia sac (0%), in contrast to 43% in type 3B. Peritoneal injury during operation and local hematoma/seroma were the most common complications (8.1% and 8.9%, respectively). Postoperatively the patients' quality of life factors, such as the analgesics needed, number of days before a return to normal activity, number of days before a return to work, and the recurrence rate of 0.9%, were comparable with other tension-free herniorrhaphy findings reported in the past.
  
  
  CONCLUSIONS
  Our results suggest that Kugel herniorrhaphy is equally feasible for all types of Nyhus classifications, including femoral and recurrent hernias.
authors: Department of Surgery, Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan.
authors: Takeyuki
authors: T
authors: Misawa
authors: Minori
authors: M
authors: Sakurai
authors: Hideki
authors: H
authors: Kanai
authors: Masato
authors: M
authors: Matsushima
authors: Yoji
authors: Y
authors: Yamazaki
authors: Katsuhiko
authors: K
authors: Yanaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013526:Surgical Mesh; D016896:Treatment Outcome