Page 36 - herina surgery and possible lawsuits

Kmgsnorth found a reduction in immediate postoperative pam with PHS and was associated
with a shortened operative time by 4 to 5 minutes. [73]

Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein
method for open inguinal hernia repair for short- and long-term results did not show any
clinically significant difference in postoperative pam and quality of life between the three
types of mesh hernia repair. Severe early postoperative pain reliably predicted the likelihood

of persisting chronic groin pain. [74, 75]
Kugel repair

The Kugel repair is considered a simple and minimally invasive repair, but non laparoscopic

preperitoneal repair, its success is dependent on the experience and training of the surgeon.
The Kugel repair combines the ease of an anterior approach with mesh placed m the
preperitoneal position. The mesh is designed to expand mto its M l dimensions after being

rolled or folded and placed in the preperitoneal space through a relatively small openmg. A 2-
to 3-cm incision is located halfway between the superior iliac spme and the pubic tubercle
passing through the external oblique, internal oblique, and transversahs fascia. Any indirect
sac is ligated or inverted. The inferior epigastric vessels are identified and should remain

attached to the transversalis fascia while the peritoneum is freed from the postenor aspect of
the transversalis fascia, creating a preperitoneal pocket in which to place the Kugel patch.

The Kugel patch, typically a standard size of 8 12 cm, inserted mto the preperitoneal space
and allowed to expand. The patch secured with a smgle stitch and allowed to cover the defect.
The suture holds it in place and then held m place by the natural mtra-abdommal forces
(Pascal's principle) from the peritoneum as the patient stands and proceeds with normal

activities. [76]

JQ
Figure 14- Kugel Patch.

"Race-track" oval shaped polypropylene
mesh graft with pocket for insertion and
larger gauge polypropylene ring to hold
graft's flat shape, (a) inner and outer welds;

(b) transverse slit; (c) outer apron, (d )
tissue apposition hole and v-shaped
cut.[76]

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