Topical perioperative antibiotic prophylaxis for minor clean inguinal surgery

In minor clean procedures, such as inguinal hernia repair and varicocelectomy, the efficacy of systemic perioperative antibiotic prophylaxis is not well established. To determine the efficacy of topical antibiotic prophylaxis alone in preventing postoperative wound infection in a minor urologic clean procedure, we retrospectively reviewed the medical records of 1,654 patients who had undergone microsurgical varicocelectomy.

From September 1985 until December 2000, 1,654 men underwent 2,554 microsurgical varicocelectomies (900 bilateral) by a single surgeon (MG). The skin was shaved and then prepped with standard Betadine gel (Purdue Frederick) that was wiped away with 70% ethanol. No systemic antibiotics were used. The wound was irrigated with 1% neomycin at the moment the incision was made, and then every few minutes until the completion of the procedure, which averaged 45 minutes per side. No postoperative antibiotics were used.

No wound infections occurred. No patient developed an adverse reaction to topical application of neomycin. One can conclude that the infection rate in this study is no higher than 0.2% with 95% confidence.

Our review of a large series of consecutive clean urologic procedures indicates that by combining a skin preparation of Betadine gel and 70% ethanol with perioperative topical neomycin irrigation at the moment of skin incision, the risk of postoperative wound infection when performing microsurgical varicocelectomy can be effectively reduced to less than 0.2%.