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Prophylactic antibiotics in open mesh repair of inguinal hernia - a randomized controlled trial
V Gomathi Shankar1, K Srinivasan, Sarath C Sistla
1Department of Surgery, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Puducherry 605006, India. drgomathishankar@gmail.com
Abstract:
The role of prophylactic antibiotics in mesh repair of inguinal hernia is unclear. A Cochrane meta-analysis in 2005 concluded that "antibiotic prophylaxis for elective inguinal hernia repair cannot be firmly recommended or discarded" and "further studies are needed, particularly on the use for mesh repair." So, we designed a study to define the role of prophylactic antibiotics in mesh repair of inguinal hernia. We conducted a prospective, randomized, double-blind, trial comparing wound infection rates in 450 patients (225 received intravenous Cefazolin, 225 received a placebo) undergoing primary inguinal hernia repair electively using polypropylene mesh. 334 patients who completed a followup period of one month were analyzed. Age, American Society of Anesthesiologists class, type of hernia, type of anesthesia, grade of surgeon, pre and postoperative hospital stay and duration of operation were recorded. CDC criteria was used to define wound infection. Groups were well matched for all preoperative variables studied. The overall infection rate was 8.7% (29 out of 334). The incidence of wound infection in antibiotic group was 7% and 10.5% in control group. One from each group developed deep surgical site infection. Most of the infections occurred between the 7th and 12th post-operative day after discharge from the hospital. Antibiotic prophylaxis was associated with decreased incidence of wound infection when compared to control group, but the difference was not statistically significant. Based on our results we do not recommend the routine use of antibiotic prophylaxis in elective mesh repair of inguinal hernias.
Insights
Prophylactic antibiotics did not significantly reduce wound infections in elective inguinal hernia mesh repair. Routine antibiotic use is not recommended for this procedure.
Area of Science:
- Surgical Oncology
- Infectious Diseases
- Clinical Trials
Background:
- The necessity of prophylactic antibiotics for inguinal hernia mesh repair remains uncertain.
- Previous meta-analyses suggest further research is needed, especially for mesh repairs.
Purpose of the Study:
- To determine the role of prophylactic antibiotics in preventing wound infections during elective inguinal hernia repair using mesh.
- To compare infection rates between patients receiving Cefazolin and those receiving a placebo.
Main Methods:
- A prospective, randomized, double-blind trial involving 450 patients undergoing elective inguinal hernia repair with polypropylene mesh.
- 225 patients received intravenous Cefazolin, while 225 received a placebo. Wound infection rates were assessed using CDC criteria over a one-month follow-up.
Main Results:
- The overall wound infection rate was 8.7%. The antibiotic group had a 7% infection rate, compared to 10.5% in the placebo group.
- While antibiotic prophylaxis showed a trend towards decreased infection, the difference was not statistically significant.
- Deep surgical site infections occurred in one patient from each group, with most infections appearing post-discharge.
Conclusions:
- Prophylactic antibiotics did not demonstrate a statistically significant benefit in reducing wound infections for elective inguinal hernia mesh repair.
- Routine use of antibiotic prophylaxis is not recommended for this surgical procedure based on these findings.
