title: Do we need antibiotic prophylaxis in endoscopic inguinal hernia repair? Results of the Herniamed Registry.
abstract: BACKGROUND
  The use of antibiotic prophylaxis in inguinal hernia repair is a controversial issue. Accepted randomized controlled trials or registry data with specific analysis of endoscopic repaired patients do not exist.
  
  
  METHODS
  The data presented in this study compared the prospectively collected data from the Herniamed Registry on all patients who had undergone unilateral, bilateral or recurrent repair of inguinal hernias using either endoscopic or open techniques between September 1, 2009, and March 5, 2014. In total, 85,033 patients were enrolled. Of these patients, 48,201 (56.7 ) had an endoscopic and 36,832 (43.3%) an open repair. The target variables analyzed were impaired wound healing and deep infections with mesh involvement within 30 days after the operation.
  
  
  RESULTS
  Analysis of the patient group with endoscopic/laparoscopic inguinal hernia repair (n = 48,201) did not identify any significant influence of antibiotic prophylaxis on postoperative impaired wound healing, which occurred in 53 cases (p = 0.6431). Nor was it possible to identify any significant impact of antibiotic prophylaxis on the deep infections seen in 27 cases (p = 0.8409). Analysis of the open inguinal hernia repair group revealed that, unlike the laparoscopic/endoscopic group, antibiotic prophylaxis had a significant impact on the postoperative impaired wound healing and deep infection rates. The risk of postoperative impaired wound healing with antibiotic prophylaxis was significantly lower [OR 0.677 (0.479; 0.958), p = 0.027].
  
  
  CONCLUSIONS
  The positive impact of the endoscopic/laparoscopic technique on avoidance of impaired wound healing and deep infections with mesh involvement is already so great that antibiotic prophylaxis has no additional benefit. In contrast, antibiotic prophylaxis should be administered for open inguinal hernia repair.
authors: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
authors: F
authors: F
authors: Köckerling
authors: Winghofer Medicum, Hernia Center, Winghofer Straße 42, 72108, Rottenburg am Neckar, Germany.
authors: R
authors: R
authors: Bittner
authors: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
authors: D
authors: D
authors: Jacob
authors: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
authors: C
authors: C
authors: Schug-Pass
authors: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
authors: C
authors: C
authors: Laurenz
authors: StatConsult GmbH, Halberstädter Straße 40 a, 39112, Magdeburg, Germany.
authors: D
authors: D
authors: Adolf
authors: StatConsult GmbH, Halberstädter Straße 40 a, 39112, Magdeburg, Germany.
authors: T
authors: T
authors: Keller
authors: Hernia Center Cologne, PAN - Hospital, Zeppelinstraße 1, 50667, Cologne, Germany.
authors: B
authors: B
authors: Stechemesser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012042:Registries; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Endoscopic inguinal hernia repair; Postoperative complications; TAPP; TEP; Wound infection