Mohammad Azeem, Zia Ullha, Saifullah Gorya, Azhar Bashir, Muhammad Arshad Cheema.
Modified Kugel Versus Lichtenstein Operation for Inguinal Hernia Repair: a Prospective Randomized Study.
Annals Punjab Med Coll Jan ;9(3):117-23.

Objectives: The purpose of this prospective randomized clinical study was to compare the outcome regarding pain and recurrence following Lichtenstein repair with Modified Kugel repair of inguinal hernias. Study Design: This was a prospective randomized clinical study Materials and Methods: Patients with inguinal hernia who were treated during Sep. 2010 to May 2012 using Preperitoneal Modified Kugel approach (PP group, n: 89) and the Anterior Lichtenstein approach (AL group n:87). The operation time, hospital stay, postoperative complications and recurrence after surgery were assessed and compared statistically in both groups. Results: A total of 176 patients (173 men and 03 women) randomized to either group PP or group AL. No significant differences were observed regardingseroma and infection in both groups, however postoperative hematoma and operative time were  higher in AL Group without any statistical significance (p< 0.098).The rate of recurrence and pain were significantly high with  in AL group versus PP Group during period of follow up time (23.34 +/- 1.07 months Vs 23.01 +/- 0.13 months in group PP and AL respectively). The operative time in Preperitoneal Modified Kugel Repair (PP Group) was 45.16 +/- 10.14 minutes and 52.34 +/- 07.04 minutes for Anterior Lichtenstein Repair (AL Group). Conclusion: Modified Kugel Repair of Inguinal Hernia is minimal invasive method and as safe as Anterior approach with less recurrence and pain than Lichtenstein operation.

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