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Link to original content: http://pubmed.ncbi.nlm.nih.gov/22336793/
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Review
. 2012 Feb 15;2012(2):CD003769.
doi: 10.1002/14651858.CD003769.pub4.

Antibiotic prophylaxis for hernia repair

Francisco Javier Sanchez-Manuel  1 , Javier Lozano-García, Juan Luis Seco-Gil
Affiliations
Review

Antibiotic prophylaxis for hernia repair

Francisco Javier Sanchez-Manuel et al. Cochrane Database Syst Rev. .

Update in

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: 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.

Selection criteria: Only randomised clinical trials were included.

Data collection and analysis: 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.

Main 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).

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.

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Conflict of interest statement

None known.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Funnel plot of comparison.
4
4
Forest plot of comparison: 1 Antibiotic prophylaxis vs Placebo, outcome: 1.1 Wound infection.
5
5
Sensitivity analysis excluding each of the studies and their relationship to main analysis.
1.1
1.1. Analysis
Comparison 1 Antibiotic prophylaxis vs Placebo, Outcome 1 Wound infection.
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References

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