Antibiotic prophylaxis in incisional hernia repair using a prosthesis

Abstract

Antibiotic prophylaxis in clean surgery with implantation of prosthetic material is widely accepted, although there are no studies on its use in abdominal incisional hernia repair. The objective was to evaluate antibiotic chemoprophylaxis in incisional herniorrhaphy with the implantation of prosthetic material. A prospective non-randomized study (1990-1998) was conducted to analyse 216 patients undergoing surgery for abdominal incisional hernia who required a prosthesis (polypropylene) in the reconstruction and who met the criteria for clean surgery. Risk factors were observed in 31.5%, the most frequent being diabetes and obesity. The incisional hernia was located mostly in the abdominal midline and in 64.4% measured over 10 cm. Antibiotic prophylaxis was administered in 140 patients (64.8%) via the systemic route, the antibiotics being first- or second-generation cephalosporins or amoxicillin-clavulanic acid. Surgical wound infection occurred in 39 patients (18.1%), 19 who had received antibiotic prophylaxis (13.6%) and 20 who had not (26.3%). In multivariate analysis using logistic regression, the variables with statistical significance for local septic infection were antibiotic prophylaxis and number of risk factors. We can conclude therefore that antibiotic chemoprophylaxis is useful in abdominal incisional herniorrhaphy surgery with implantation of prosthetic material for reducing local septic complications.

Short- and long-term outcomes of incarcerated inguinal hernias repaired by Lichtenstein technique.

“…A systematic review of the literature suggests that such an approach is reasonable [25–27]. However, this attitude is not widely accepted [28].…”

Resistance of Synthetic and Biologic Surgical Meshes to Methicillin-ResistantStaphylococcus aureusBiofilm: AnIn VitroInvestigation

“…While synthetic meshes have undoubtedly been effective in reducing inguinal hernia recurrence rates [3–5, 21], there are complications that correlated with their use including adhesion, fistulas, and most notably infection [7]. With mesh-related infection rates of 9% reported for open inguinal hernia repair [22] and open incisional hernia repair infection rates as high as 18% [10], complications from mesh repair remain significant. In fact, further development of biologic meshes for abdominal wall reconstruction was mainly inspired by the persistence of complications, including infection, following synthetic mesh implantation [2].…”

“…This research focuses on mesh-related infection, which is the most significant clinical complication relating to mesh implantation. Infection has been shown to occur in 1-2% of all cases involving mesh [8, 9] and up to 18% of open incisional hernia repair cases [10].…”

Prosthetic Meshes for Hernia Repair: State of Art, Classification, Antimicrobial Approaches, and Fabrication Methods

“…S. aureus [198] and Staphylococcus epidermidis [199] are the most common microorganisms related to mesh infection (approximately 90%), S. aureus (MRSA) [200], involved in up to 63% of surgical site mesh-related infections [201][202][203], being methicillin-resistant. Other microorganisms related to mesh infection include Streptococcus pyogenes [204], Enterococcus faecalis [205,206], Pseudomonas sp. [204], Escherichia coli, Klebsiella pneumonia [207,208], Propionibacterium acnes and Candida albicans [209][210][211].…”