The Kugel Approach to Hernia Repair

Nonsurgical treatment is only a temporary solution to hernias, which must be surgically repaired at some point - and should be repaired before complications have the chance to arise.

Hernia procedures have traditionally fallen under either the open or laparoscopic category. The first, more traditional, approach is done from the outside through an incision in the groin or the area of the hernia. The surgeon chooses to use a small piece of the surgical mesh to repair the defect or hole, and the technique can be done under local or general anesthetic. The second approach utilizes a laparoscope and a series of trocars inserted through small incisions to repair the defect from the inside. A piece of surgical mesh is used in this procedure, as well.

An alternative approach developed by Olympia, Washington physician Robert D. Kugel uses the advantages of laparoscopy by placing the patch underneath the hole rather than sewing it on top of the tear as in the traditional open approach. However, the Kugel method does not necessitate placing a laparoscope and series of trocars inside the patient. In fact, the patch design allows for an open, preperitoneal repair that offers all the benefits of a laparoscopic hernia repair without the possible complications and costs. this less invasive outpatient procedure also achieves excellent results: More than 15,000 cases have been completed with less than a 1% recurrence rate.

The Kugel Technique

The Kugel procedure involves identifying and reducing the hernia through a transverse incision made midway between the pubic tubercle and the anterior superior iliac spine. A pocket is developed large enough to accept the double-layer monofilament polypropylene patch, which is pliant enough to easily place through a 3-cm to 4-cm incision. The patch is available in five sizes and can be used for all ventral and incisional hernias.

The unique design of the Kugel patch features a patented "memory recoil ring" that allows the patch to spring open and maintain its shape during placement and that creates a positioning pocket used to guide the patch into place. The design also allows for a "tension-free" mesh repair technique, therefore significantly reducing operating time and post-operative pain.
 

As the mesh lies deep to the muscle and the ring extends sufficiently beyond the fascial edges, eliminating the need for anchoring sutures laterally, it is only necessary to secure the patch at the fascial edges with a single suture. The patch is thus anchored against the abdominal wall. In other methods, multiple sutures are necessary all around the mesh implant to hold it in place, which brings the tissues in the abdomen under tension, leading to pain.

An added benefit of the Kugel patch is that it covers the entire inguinal floor, including three potential hernia sites: direct, indirect and femoral. Not only does this repair fix the current hernia, it also protects against any future hernias in this area.

Unlike a laparoscopic hernia repair, the majority of cases of the Kugel technique are being performed using local anesthesia with IV sedation. This leads to a rapid recovery and an operation time of 15 to 25 minutes.

Patients may undergo light activity immediately after surgery, and in many cases patients require little or no pain medication. Studies show that most patients can return to work within three days.

A Resource for the Kugel Technique

Dr. William G. Cloud offers the Kugel hernia repair procedure to patients who meet the criteria for this less invasive procedure. A board-certified surgeon with experience in cancer and abdominal surgery, Dr. Cloud has extensive expertise in advanced laparoscopic surgery and complex gastrointestinal procedures. He has performed many hernia operations with much success, and in addition, he has trained surgeons form North and South Carolina in the Kugel method for the past three years.

Dr. Cloud is a referral source for numerous physicians confident in his skills and commitment to patient care, and he welcomes your hernia cases, as well. For more information, call Dr. Cloud at 828.437.0847.