Antibiotic prophylaxis for hernia repair.
Abstract
Background
The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area.
Objectives
The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair.
Search methods
In the present review, we searched for eligible trials in June 2009, using the search terms below. This revealed one new included trial (total of thirteen).
We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline and Embase was conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies.
Selection criteria
Only randomized clinical trials were included.
Data collection and analysis
Thirteen randomized clinical trials were identified. Seven of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis.
Main results
The total number of patients included was 6825 (prophylaxis group: 4188, control group: 2637). Overall infection rates were 2.8% and 3.9% in the prophylaxis and control groups, respectively (OR 0.64, 95%CI 0.48 ‐ 0.85).
The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 ‐ 1.00).
The subgroup of patients with hernioplasty had infection rates of 1.4% and 2.9% in the prophylaxis and control groups, respectively (OR 0.49, 95% CI 0.29 ‐ 0.86).
Authors' conclusions
Based on the results of this systematic review the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended against when high rates of wound infection are observed.
PICOs
Plain language summary
Administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended.
The use of antibiotic prophylaxis for elective hernia repair is currently a controversial issue. Although elective hernia repair is considered a clean procedure, the rate of postoperative wound infection in many countries exceeds the one expected for clean surgery, increasing discomfort in patients and health care expenses. In addition, antibiotics administration is not exempt of potential risks.
Controlled clinical trials on the use of antibiotic prophylaxis for hernia repair are scarce, the number of patients studied is low and the results are diverse. Based on the results of this meta‐analysis of randomized clinical trials, administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended when high rates of wound infection are observed.
