Elective inguinal hernia repair with mesh: is there a need for antibiotic prophylaxis?--A review

Although it is widely accepted that antibiotic prophylaxis is indicated in elective mesh repair of inguinal hernia, the evidence for its value has been controversial. A recent Cochrane meta-analysis showed that there is insufficient data overall to demonstrate a clear advantage of prophylaxis and illustrated the classic problem in evidence-based medicine where a lack of evidence in support of an intervention may be interpreted as a reason not to implement it. This review of the literature evaluates the evidence for the effectiveness of intravenous antibiotics as prophylaxis in inguinal hernia repair with mesh. Pubmed and Embase searches revealed seven trials of antibiotic prophylaxis in mesh repair of inguinal hernia. The quality of the evidence and the limitations of the seven trials are discussed. Analysis of these seven trials adds to the Cochrane meta-analysis of Sanchez-Manuel and Seco-Gil. Only two of the trials support the use of antibiotic prophylaxis, and those were the only double-blind randomized controlled trials reviewed. In evidence-based medicine the absence of evidence in clear support of an intervention (as in this review, where only two of the seven trials support the use of antibiotic prophylaxis) may be taken as reason not to implement the intervention. It is possible, however, that what is needed to clarify the issue are further randomized controlled trials, rigorously performed and recruiting significantly larger numbers of patients.