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Postmesh herniorrhaphy wound infections: can they be eliminated?
1Department of Surgery, Winthrop University Hospital, Mineola, New York, USA. maxdey@optonline.net
Abstract:
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.
Insights
Implementing strict aseptic and antiseptic protocols, including cefazolin and gentamycin wound irrigation, drastically reduced surgical site infections for hernia repair. This approach achieved a near-zero infection rate, demonstrating improved patient safety in herniorrhaphy procedures.
Area of Science:
- Surgical Infection Prevention
- Antimicrobial Strategies
- Hernia Repair Outcomes
Background:
- Current infection rates for inguinal herniorrhaphy (3-4%) are unacceptably high.
- Advancements in understanding bacterial biofilm dynamics offer opportunities to reduce surgical site infections.
- Existing aseptic and antiseptic techniques require optimization for hernia repair procedures.
Purpose of the Study:
- To evaluate the effectiveness of stringent aseptic and antiseptic measures in reducing post-herniorrhaphy infection rates.
- To demonstrate that near-zero infection rates are achievable in inguinal and ventral herniorrhaphy.
- To provide evidence supporting the application of enhanced infection control in general surgery.
Main Methods:
- Reinstitution of established aseptic regimens.
- Administration of intravenous cefazolin (1g) one hour pre-surgery.
- Frequent wound irrigation with a solution of gentamycin sulphate (80mg/250ml normal saline).
Main Results:
- Achieved an infection rate of 0.11% across over 4,000 inguinal and 350 ventral herniorrhaphies.
- The last recorded wound infection in the service was in 1983.
- Sustained low infection rates suggest the efficacy of the implemented protocol.
Conclusions:
- Stringent aseptic and antiseptic protocols are highly effective in preventing surgical site infections after herniorrhaphy.
- The combination of cefazolin and gentamycin irrigation significantly lowers infection risk.
- Achieving infection-free outcomes in hernia repair is a realistic and attainable goal.
