Inguinal Hernia Recurrence following Preperitoneal Kugel Patch Repair

Three hundred eighty-six preperitoneal inguinal herniorrhaphies using a polypropylene Kugel patch (Davol) were performed in 355 consecutive patients by six surgeons. Variables for recurrence evaluated included age, gender, hernia type, whether the Kugel patch was placed for a primary or recurrent hernia, and the experience of the surgeon. Of 336 patients with long-term follow-up available (18 months to 63 months, median 42 months) 28 recurrences developed 1 to 48 months (mean 16 months) after 366 Kugel patch repairs (7.7%). Recurrence was highest (27.8%) in the subset of patients who had a Kugel patch placed for recurrent inguinal hernias (P < 0.05). Patients with direct primary hernias involving the entire floor had a recurrence rate of 22.7 per cent (P < 0.05). Patient age and gender had no bearing on recurrence. Surgeon experience did play a role, as the recurrence rate was 18.2 per cent during each surgeon's first 36 cases and 2.9 per cent thereafter (P < 0.0005). Surgeons using a preperitoneal Kugel patch for inguinal herniorraphy had a recurrence rate that was unacceptably high. The technique may not be suitable for repair of recurrent inguinal hernias or primary large direct inguinal hernias. Surgeons in this study saw a learning curve of 36 cases.