title: 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.
  
  
  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
  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 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). National Research Register, ISI-Web, DARE, Scirus, TRIPDATABASE, NHS EED, reference list of the included studies and web of clinical trials register (www.controlled-trials.com and clinicaltrials.gov) were checked to identify further studies.
  
  
  METHODS
  Only randomised clinical trials were included.
  
  
  METHODS
  In the present review, we searched for eligible trials in October 2011. This revealed four new included trials, so seventeen trials are included in the meta-analysis. Eleven of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorrhaphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A fixed effects model was used in the analysis.
  
  
  RESULTS
  The total number of patients included was 7843 (prophylaxis group: 4703, control group: 3140). Overall infection rates were 3.1% and 4.5% in the prophylaxis and control groups, respectively (OR 0.64, 95% CI 0.50 - 0.82). 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 2.4% and 4.2% in the prophylaxis and control groups, respectively (OR 0.56, 95% CI 0.38 - 0.81).
  
  
  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.
authors.affiliation: General and Digestive Surgery, Complejo Asistencial Universitario de Burgos. Hospital General Yagüe, Burgos, Spain. frajasama@telefonica.net
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Sanchez-Manuel
authors.forename: Javier
authors.initials: J
authors.lastname: Lozano-García
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Seco-Gil
mesh_terms: D019072:Antibiotic Prophylaxis; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000517:prevention & control*