Recently, a tension-free method employing a polypropylene mesh has been widely used for the repair of inguinal hernias in adult. At our hospital, we have used the Kugel technique, in which a patch is inserted into the anterior peritoneal cavity by means of an anterior approach, since June 2003. This technique has been used to treat 120 patients (135 hernias) as of October 2005. Good results have been obtained. With the Kugel technique, the wound is small and the stripped anterior peritoneal cavity is deep, increasing the risk of bleeding. This technique is therefore contraindicated in patients who are very obese or have large incarcerated inguinal hernias. We describe our experience with a patient who had a large incarcerated inguinal hernia with prolapse of the small intestine. The Kugel technique was modified and able to be performed safely and successfully. We describe this technique, along with a discussion of the literature
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