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Surg Endosc. 2015 Dec;29(12):3741-9. doi: 10.1007/s00464-015-4149-2. Epub 2015 Mar 19.

Do we need antibiotic prophylaxis in endoscopic inguinal hernia repair? Results of the Herniamed Registry.

Author information

1
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.
2
Winghofer Medicum, Hernia Center, Winghofer Straße 42, 72108, Rottenburg am Neckar, Germany.
3
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
4
StatConsult GmbH, Halberstädter Straße 40 a, 39112, Magdeburg, Germany.
5
Hernia Center Cologne, PAN - Hospital, Zeppelinstraße 1, 50667, Cologne, Germany.

Abstract

INTRODUCTION:

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.

PATIENT AND 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].

CONCLUSION:

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.

KEYWORDS:

Antibiotic prophylaxis; Endoscopic inguinal hernia repair; Postoperative complications; TAPP; TEP; Wound infection

PMID:
25786905
PMCID:
PMC4648957
DOI:
10.1007/s00464-015-4149-2
[Indexed for MEDLINE]
Free PMC Article

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