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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
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Hernia, mesh, and topical antibiotics, especially gentamycin: seeking the evidence for the perfect outcome…
1Department of Surgery, Recep Tayyip Erdoğan University , Rize , Turkey.
Abstract:
Inguinal hernia repair is a clean surgical procedure and surgical site infection (SSI) rate is generally below 2%. Antibiotic prophylaxis is not routinely recommended, but it may be a good choice for institutions with high rates of wound infection (>5%). Typical prophylaxis is the intravenous application of first or second-generation cephalosporins before the skin incision. However, SSI rate remains more than 2% in many centers in spite of intravenous antibiotic prophylaxis. Even a 1% SSI rate may be unacceptable for the surgeons who specifically deal with hernia surgery. A hernia center targets to be a center of excellence not only in respect of recurrence rate but also for other postoperative outcomes, therefore a further measure is required for an excellent result regarding infection control. Topical gentamycin application in combination with preoperative single-dose intravenous antibiotic may be a useful to obtain this perfect outcome. Data about this subject are not complete and high-grade evidence has not been cumulated yet. Prospective randomized controlled trials can make our knowledge more solid about this subject and help the surgeons who seek perfect outcome regarding infection control in inguinal hernia surgery.
Insights
To reduce surgical site infections (SSI) in inguinal hernia repair, topical gentamycin combined with intravenous antibiotics may offer improved outcomes. Further research is needed to confirm its effectiveness for excellent infection control.
Area of Science:
- Surgical Infection Prevention
- Hernia Surgery Outcomes
Background:
- Inguinal hernia repair is a clean surgery with typically low surgical site infection (SSI) rates (<2%).
- Standard antibiotic prophylaxis is not routinely recommended but may be considered for centers with high SSI rates (>5%).
- Despite current prophylaxis, SSI rates often exceed 2%, prompting a need for enhanced infection control measures.
Purpose of the Study:
- To explore the potential of topical gentamycin combined with intravenous antibiotics to achieve excellent infection control in inguinal hernia repair.
- To address the need for improved postoperative outcomes beyond recurrence rates in hernia surgery.
Main Methods:
- The study discusses the potential of combining topical gentamycin with preoperative single-dose intravenous antibiotics.
- It highlights the current lack of comprehensive data and high-grade evidence on this combined approach.
- The need for prospective randomized controlled trials is emphasized to solidify evidence.
Main Results:
- Current data on the efficacy of topical gentamycin in conjunction with intravenous antibiotics for inguinal hernia repair is incomplete.
- High-grade evidence supporting this combined approach is not yet available.
- The potential for this method to achieve infection rates below 1% is suggested but requires further investigation.
Conclusions:
- A combination of topical gentamycin and preoperative intravenous antibiotics may be a valuable strategy for achieving superior infection control in inguinal hernia repair.
- Further high-quality research, particularly prospective randomized controlled trials, is essential to validate this approach.
- Hernia centers aiming for excellence in all postoperative outcomes should consider investigating advanced infection control methods like this combination therapy.
