成人鼠径ヘルニアに対するメッシュプラグ法と比較した Kugel 法の優位性 [in Japanese] THE SUPERIORITY OF KUGEL METHOD COMPARED TO MESH PLUG METHOD FOR INGUINAL HERNIA IN ADULTS [in Japanese]
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近年,成人鼠径ヘルニアの手術のなかでも数多くの利点を持つKugel法が広まりつつある. Kugel法は他のtension freeの方法と比較して,手術操作も少なく単純な術式であるが,パッチを留置する腹膜前腔は解剖学的に馴染みが薄いため,習熟にある程度の経験を要するのが難点と言われる.今回われわれは, Kugel法導入後16カ月間に同一術者が行った38例について手術時間のlearning curveを算出し,技術の習熟に要する症例数を検討した.また,主にKugel法導入前に行った37例のメッシュプラグ法と比較した.平均手術時間はKugel法29.6分,メッシュプラグ法47.3分であった.一人の術者でKugel法の手技が安定するには15～20例の経験を要すると思われた. Kugel法はある程度の経験を要するものの,習熟すれば非常に短時間で確実に施行できる,利点の多い方法であると考えられた.
Among many operative procedures for inguinal hernia in adults, Kugel method which has a variety of benefits has increasingly employed in recent years. Compared with other tension free procedures, Kugel method is a simple procedure requiring less operative manipulations. However, it is a difficult point of Kugel method that the acquaintance of skill demands experiences in some degree, because we are anatomically unfamiliar to the preperitoneal cavity at where a patch is placed. In this study we calculated the learning curve of operating time in 38 cases in which one surgeon had performed Kugel method for 16 months after the introduction of it, in order to draw the number of cases to acquire the skill. Moreover a comparison was made between these 38 cases and another 37 cases in which mesh plug method was performed before the introduction of Kugel method. Average operating time was 29.6 min in Kugel method versus 47.3min in mesh plug method. It is inferred that reliable operating skill is able to be attained by experiences with 15-20 cases for one surgeon. Although Kugel method demands experiences in some degree, once surgeons are versed in the technique and the method would become an advantageous method which would promise reliable performance in a very short time.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(10), 2285-2288, 2006-10-25
Japan Surgical Association