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Modified Kugel open technique
Hi –
I’ve had a left inguinal hernia for 4 years and recently decided to finally have surgery. I am very anxious and most concerned about post-op long term pain and mesh issues.
I recently saw an experienced surgeon who wants to do a modified kugel open repair. He describes this as a double layer of mesh and I am concerned that this is overkill for my small (5mm) symptomatic hernia. I would like to have the least possible mesh, in case removal is necessary in the future…not that I am anticipating this.
Previously, I had been looking into non-mesh options but have not found a surgeon in Missouri who thinks this is a good option. Can anyone tell me more about modified kugel procedures?
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2 Replies
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Modified Kugel open technique
You have done your homework. To repair a small 5mm hernia with a double layered mesh is in my opinion crazy.. It seems that for some surgeons, the only criteria for success is no recurrence.. I would swap this severe pain caused by the mesh against recurrence any day.
Most studies on different types of hernia repair just show the figures of “chronic pain”, but doesn’t differentiate between life changing severe pain that some people get with mesh complications, and some discomfort now and then.
I have already made the mistake of having what they called a minimally invasive surgery with a very experienced hernia surgeon. The laparoscopic procedure itself is minimally invasive, but the 15x13cm mesh is not.
For a small hernia like you have I think you should stay on the path of finding a very good surgeon who can perform either Shouldice or Desarda. If mesh repair is the only option, I would choose a mesh like Tigr Matrix or Phasix and not a permanent mesh.
I’m no doctor, this is just my opinion based on the research i’ve done myself and my experience with hernia surgery.
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Modified Kugel open technique
The Kugel approach for hernia repair is well described. I’m. It sure what the modified Kugel implies.
It is basically an open anterior approach repair with mesh. The Kugel patch that is used is a two layer ringed mesh.
There are many surgeons who offer this repair and have good results.
In my opinion a) the Kugel mesh used is too thick and bulky for the groin and b) for primary repairs there is little benefit to this over a laparoscopic repair.
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