Laparoscopic Inguinal Hernia Repair With the Composix Kugel Patch

Laparoscopic placement of the Kugel patch using a preperitoneal approach is the ideal method for hernioplasty repair because it is less invasive than the conventional open method. We first used a laparoscopic total extraperitoneal approach to place the Kugel patch, which is similar to the open approach; however, we encountered technical difficulty. We then used a laparoscopic intraperitoneal onlay approach. We performed laparoscopic hernioplasty using the Composix Kugel Patch in 5 patients. All 5 had a monolateral hernia; 1 case was recurrent. Only the polypropylene side of the mesh was fixed with titanium spiral tacks. An additional 3-0 polydioxanone (PDS) suture was used to prevent migration of the intra-abdominal organs and to fix the mesh to the abdominal wall. No intraoperative complications occurred, and no conversion was necessary. The mean duration of surgery was 77 minutes. No postoperative complications were observed, except for one small seroma. Four patients were administered intravenous analgesics after the first 24 hours of surgery. The results indicate that the intraperitoneal onlay approach may be feasible, safe, and effective for the treatment of inguinal hernias, especially recurrent hernias. This approach has been shown to be safer than other more commonly performed laparoscopic hernioplasties (e.g., transabdominal preperitoneal repair and total extraperitoneal repair).