Systemic inflammatory response after Kugel versus laparoscopic groin hernia repair: a prospective randomized trial.
BACKGROUND
Kugel repair, a minimally invasive technique, has become an alternative to laparoscopic groin hernia repair, but the technique has not been adequately evaluated by assessment of objective parameters. A prospective randomized clinical study was carried out to compare the systemic inflammatory response to surgical trauma and clinical outcomes in patients who underwent groin hernia repair by the Kugel and totally extraperitoneal (TEP) laparoscopic methods.


METHODS
Forty consecutive patients admitted for unilateral groin hernia were randomized to Kugel (n = 20) or TEP (n = 20) repair under general anesthesia. Operation time, length of hospital stay, pain severity, time to return to normal activities, cost, and systemic inflammatory and hormone responses to surgical trauma were compared.


RESULTS
There were no significant between-group differences in duration of operation, length of hospital stay, time to return to normal activities, or mean visual analogue scale (VAS) score (p > 0.05 for each). Serum cortisol, high-sensitivity C-reactive protein (hsCRP), and interleukin (IL)-6 concentrations before surgery, and 1 and 24 h after surgery, did not differ significantly in the two groups (p > 0.05). There were no recurrences or complications during follow-up. Cost per patient was US $546 lower in the Kugel group.


CONCLUSIONS
Kugel herniorrhaphy is a minimally invasive technique that offers all the advantages of TEP and is more cost-effective.
Department of General Surgery, S. B. Okmeydaný Training and Research Hospital, İstanbul, Turkey. omerbender@hotmail.com
Omer
O
Bender
Fatih Levent
FL
Balcı
Enis
E
Yüney
Fazıl
F
Sağlam
Yaşar
Y
Ozdenkaya
Yavuz Selim
YS
Sarı
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D006552:Hernia, Inguinal / Q000097:blood / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000097:blood / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology*; D011446:Prospective Studies; D012008:Recurrence; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*; D016896:Treatment Outcome
D015850:Interleukin-6; D002097:C-Reactive Protein; D006854:Hydrocortisone