Choosing Method of Repair

Hernia Discussion Forums Hernia Discussion Choosing Method of Repair

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    • #10805

      – In deciding between open or laparoscopic surgery, how much consideration is given to the risks/negative effects of general anaesthetic vs local – particularly on the brain?

      – Do any of the surgeons here perform or recommend the “open preperitoneal” or Kugel technique? From what I understand, the mesh is placed in the back of the muscle (as with laparoscopic repair) but that it can be performed with a keyhole incision and local anaesthetic. According to Dr. Reinhorn of Boston, the recovery time is shorter than with either laparoscopic or traditional inguinal surgery.

      – I’ve heard that in female patients, the round ligament is sometimes cut – what determines this and can it cause problems down the road?

      – is laparoscopic repair possible without mesh?

      Thank you!

    • #14048
      drtowfigh
      Keymaster

      Choosing Method of Repair

      – risks and benefits of anesthesia options are variable for each patient. Usually risks are related to increasing age.

      – the Kugel technique is a very good technique. It’s fallen out of favor as less surgeons are performing it. I use it for only certain situations. It’s good to have in one’s armamentarium.

      – yes. The round ligament is routinely cut during many Inguinal hernia operations. No problems.

      – short answer is no, laparoscopic non-mesh repair is not possible. I do offer a robotic laparoscopic non-mesh repair

    • #14049

      Choosing Method of Repair

      Thanks Dr. Towfigh,

      Can you explain why fewer surgeons are performing the Kugel technique? By the description (on various sites), it sounds like it would offer the best of both open and laparoscopic techniques(?)

    • #12478
      drtowfigh
      Keymaster

      Choosing Method of Repair

      The Kugel repair has been abandoned by many for different reasons:
      – if the space is not adequately dissected, the mesh may fold or crumble and cause meshoma with mesh-related chronic pain. Then it’s difficult to undo.
      – if the dissection of the hernia is not wide enough, hernia recurrence is higher
      – the mesh product that gave the most success is considered heavyweight and the ring is also considered too stiff–even the newer generation product.
      – repair are not promoting the Mesh used for Kugel repair.

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