Antibiotic prophylaxis for hernia repair.
BACKGROUND
The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area.


OBJECTIVE
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.


METHODS
In the present review, we searched for eligible trials in august 2006, using the search terms below. This revealed four new included trials (total of twelve). 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.


METHODS
Only randomized clinical trials were included.


METHODS
Twelve randomized clinical trials were identified. Six 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.


RESULTS
The total number of patients included was 6705 (treatment group: 4128, control group: 2577). Overall infection rates were 2.9% 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 0.48, 95% CI 0.27 - 0.85).


CONCLUSIONS
Based on the results of this meta-analysis the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Nevertheless, its administration cannot either be recommended against when high rates of wound infection are observed.
Sanchez-Manuel
F J
FJ
General Yagüe Hospital, General and Digestive Surgery, Avenida del Cid s/n, Castilla y Leon, Burgos, Spain, 09005. frajasama@telefonica.net
Lozano-García
J
J
Seco-Gil
J L
JL
D019072:Antibiotic Prophylaxis; D017558:Elective Surgical Procedures; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000517:prevention & control*