title: Kugel patch method prevents the development of a femoral hernia after inguinal herniorrhaphy.
abstract: OBJECTIVE
  A femoral hernia is a relatively rare condition, and no standard surgical methods have so far been established. In this study, we investigated the development of a femoral hernia after inguinal herniorrhaphy.
  
  
  METHODS
  A total of 1,969 patients who underwent surgery for an inguinal hernia from April 1992 to March 2012 were enrolled in this study. The patients were composed of 1,934 (98.2 %) inguinal hernia and 35 (1.8 %) femoral hernia patients. Of these, we retrospectively studied the femoral hernia cases with reference to the use of inguinal herniorrhaphy.
  
  
  RESULTS
  Of all 35 femoral hernia cases, six cases (17.1 %) were femoral type recurrences after inguinal herniorrhaphy performed by the conventional or mesh plug methods. The surgical methods used for the 35 cases were mesh plug repair in 15 cases (42.9 %), the Kugel patch method in seven (20.0 %) and conventional repair in 13 patients (37.2 %). Inguinal type recurrences developed in three cases (8.6 %) that were re-repaired by mesh plug repair or sac resection. There were no femoral or inguinal type recurrences after Kugel patch repair for a femoral hernia.
  
  
  CONCLUSIONS
  The results of this study suggested the importance of repairing all hernia orifices when repairing a groin hernia. The Kugel patch repair method is available for all inguinal region hernias by the same approach, and it seems to be useful for preventing the development of recurrence after surgery.
authors.affiliation: Department of Surgery, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, 631-0846, Japan, 99066sn@jichi.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishiwada
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Tsuji
authors.forename: Kota
authors.initials: K
authors.lastname: Nakamura
authors.forename: Tomohide
authors.initials: T
authors.lastname: Mukogawa
authors.forename: Masanori
authors.initials: M
authors.lastname: Matsusaka
authors.forename: Saiho
authors.initials: S
authors.lastname: Ko
authors.forename: Akihiko
authors.initials: A
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006550:Hernia, Femoral / Q000517:prevention & control*; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh