Postmesh herniorrhaphy wound infections: can they be eliminated?

The present infection rate of 3 to 4% for inguinal herniorrhaphy should be considered unacceptable. Modern understanding of bacterial film formation, dynamics, and molecular composition should allow the performance of virtually infection-free inguinal and ventral herniorrhaphy. In our service, the reinstitution of accepted and time-tested aseptic regimens combined with antiseptic measures consisting of 1 gram of intravenous cefazolin administered 1 hour before surgery plus frequent wound irrigations with a solution of 80 mg of gentamycin sulphate dissolved in 250 ml of normal saline solution have yielded an infection rate of 0.11% in over 4,000 clean inguinal and 350 clean ventral herniorrhaphies. Our last wound infection occurred in 1983. These results supporting the experience of orthopedic joint replacement suggest that very low postherniorrhaphy infection rates are achievable goals.