Clinical ScienceLong-term follow-up of anterior approach preperitoneal hernia repair using the Kugel patch

•We adopt anterior approach preperitoneal repair to treat inguinal hernias.•The procedure, unlike posterior approach, offers advantages of direct vision, practicable operating, and easy to learn.•It is more suitable for Chinese patients, most of whom are in an advanced stage. Our results demonstrate a low rate of recurrence and of postoperative complications.•The procedure is safe and effective after long-term follow-up.

BackgroundDespite many advantages of original Kugel hernia repair over other procedures, there exist certain disadvantages of technical difficulty, long learning curve, and high early recurrence. The aim of this study was to explore the outcomes of long-term follow-up using anterior approach preperitoneal hernia repair with the Kugel patch and determine its safety and efficacy.MethodsFive hundred eighty-one inguinal hernias were performed in 560 patients, using anterior approach preperitoneal repair. Patients' age and sex, type of hernias, operative time, hospital stay, complications, and recurrence were evaluated.ResultsWe included 581 hernias, with 354 on right side, 162 on left side, and 65 bilateral sides. All hernias were primary. There were 443 indirect hernias, 115 direct hernias, and 23 femoral hernias. Mean operative time was 50 minutes; local anesthesia was applied in 530 cases (91.2%). Postoperative complications affected 50 patients (8.9%). The patients were discharged from 4 to 8 days (with average of 6 days). The averaged follow-up time was 70 months (12 to 120 months). There were 3 recurrences in the period (.5%).ConclusionsThe results of long-term follow-up with this procedure are safe and effective, easy to learn. We believe that this procedure should be adopted as an alternative method for Chinese patients with inguinal hernias.