Page 50 - International guidelines for groin hernia management

Hernia

Wound infection rates in the high-risk environment repair, use of drains, timing of shaving, seroma aspiration,
group were 8.7% (107/1236) in the placebo group and long operative time and bilateral repairs. Due to the low
4.2% (69/1635) in the prophylactic antibiotics group incidence of infection, the number needed to treat was 323
showing a clear benefit of antibiotic prophylaxis in this to prevent one infection. Therefore, the clinical relevance
setting (OR 0.49; 95% CI 0.33–0.74, NNT 24) (Fig. 4). of this conclusion can be argued.
Fourteen (0.45%) patients developed deep surgical site There is only one small, low-quality RCT demonstrating
infections with no difference between placebo and antibi- no wound infections in any group in laparo-endoscopic IH
otic prophylaxis. repairs. Data from large patient cohorts in national registers

The 2014 annual report of the Swedish Inguinal Hernia do not support the use of antibiotic prophylaxis in these
606, 607
Register, which covers 95% of all hernia operations, patients.
revealed that 5.6% out of the 14,053 patients operated upon Special circumstances for antibiotic use
received antibiotic prophylaxis. Primarily high-risk There are very limited data on high-risk patients in a low-
patients as defined by national guidelines received antibi- risk environment. Two small studies address this issue but
otics. Postoperative infection rates were reported as 1.2% only include a few patients who might be considered to
in males and 1.5% in females. 605 have any increased risk for postoperative surgical site
Germany’s national register ‘‘HerniaMed’’ reported on infection. A consensus does not exist on what constitutes a
the use of antibiotic prophylaxis. 606 enrolling 85,000 high-risk patient in a low-risk environment for hernia
patients (57% laparo-endoscopic operations). Antibiotic surgery. However, common surgical practice includes
prophylaxis was administered in 70% of patients and antibiotic prophylaxis for increased-risk patients and these
infection was seen in 0.2% in the laparo-endoscopic group currently also include those undergoing IH repair. This is
and 0.6% in the open surgery group. In a multivariate an area ripe for further studies.
analysis on wound healing the OR was 0.318 (CI Univariate and multivariate analysis of individual trials
0.23–0.44) comparing laparo-endoscopic to open opera- reveals an increased risk of wound infections in patients
tion. It is concluded that endoscopic repair per se has such undergoing bilateral open hernia repairs and recurrent
a high benefit in reducing wound infections, that the hernia repairs. This is likely due to increased operative
administration of antibiotic prophylaxis is not necessary. time. There are insufficient data to draw conclusions on
For open repair it was concluded that there was a benefit antibiotic prophylaxis for high-risk patients with diabetes
for antibiotic prophylaxis, but this summary statement did or immunosuppression.
not account for factors like: reason for open or endoscopic

123