title: Initial experience with application of single layer modified Kugel mesh for inguinal hernia repair: Case series of 72 consecutive patients.
abstract: OBJECTIVE
  This is an initial review of the safety and efficacy of anterior preperitoneal modified Kugel (MK) mesh herniorrhaphy application without using optional onlay mesh.
  
  
  METHODS
  We retrospectively reviewed patients who underwent herniorrhaphy by a single surgeon from July 1st, 2009 to December 31st, 2010. During these 18 months, a total of 72 patients underwent single-layer MK mesh herniorrhaphy. Anterior preperitoneal approach was used to place the mesh. If the patient's inguinal hernia defect did not exceed the memory ring of MK mesh, the onlay mesh was omitted. Postoperative results (wound infection, recurrence, and chronic pain/discomfort) were recorded and analyzed.
  
  
  RESULTS
  A total of 72 patients underwent anterior preperitoneal single layer MK mesh herniorrhaphy. One patient had recurrent hernia after 1 year and was treated with a laparoscopic transabdominal preperitoneal operation. The most common postoperative complaint was mild soreness which was self-resolving after 1 month. Mean total operative time (skin to skin) was 73 minutes. The average hospital stay was 2 days. Most of the postoperative complications including soreness (14%), pain for > 3 months (1.4%), and scrotal hematoma (1.4%) were self-resolving. One patient experienced wound infection, which was treated with oral antibiotics. One patient had recurrence 1 year after the operation.
  
  
  CONCLUSIONS
  The postoperative complication and recurrence rates of single-layer MK mesh herniorrhaphy was comparable with previously reported tension-free repair. Single-layer application is safe and feasible. A longer follow-up period and larger study group with a control group are needed to verify our method.
authors.affiliation: Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Pao-Hwa
authors.initials: PH
authors.lastname: Chen
authors.affiliation: Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: 49264@cch.org.tw.
authors.forename: Heng-Chieh
authors.initials: HC
authors.lastname: Chiang
authors.affiliation: Transplant Medicine and Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yao-Li
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Jesen
authors.initials: J
authors.lastname: Lin
authors.affiliation: Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Bai-Fu
authors.initials: BF
authors.lastname: Wang
authors.affiliation: Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Meng-Yi
authors.initials: MY
authors.lastname: Yan
authors.affiliation: Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Shih
authors.affiliation: Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Jian-Ting
authors.initials: JT
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013624:Taiwan; D013718:Tensile Strength; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Kugel; herniorrhaphy; inguinal; preperitoneal; transinguinal