Original Article

J Minim Invasive Surg 2012; 15(4): 156-160

Published online December 15, 2012

https://doi.org/10.7602/jmis.2012.15.4.156

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

전복막외 복강경 탈장 교정술 시행 시 예방적 항생제 미사용에 대한 전향적 분석

이영훈ㆍ하태경

한양대학교 의과대학 외과학교실

A Prospective Study of Non-Prophylatic Antibiotics for Totally Extraperitoneal Laparoscopic Repair of Inguinal Hernia

Young Hoon Lee, M.D., Tae Kyung Ha, M.D., Ph.D.

Department of Surgery, College of Medicine, Hanyang University, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: The role of prophylactic antibiotics in totally extraperitoneal (TEP) laparoscopic repair of inguinal hernia is unclear. This study was conducted to evaluate the effects of antibiotic therapy for surgical site infection (SSI) in post TEP laparoscopic repair of inguinal hernia.
Methods: We prospectively reviewed data collected from 280 patients with inguinal hernias who were treated by TEP laparoscopic repair between August 2008 and July 2012. None of the patients received prophylactic antibiotics. Patients with a history of recurrent hernias, immune suppressive disease or diabetes mellitus were excluded from the study.
Results: There were 265 male patients and 15 female patients aged 19 to 82 years. There were 240 indirect, 38 direct, and 2 pantaloon hernias. The mean operating time was 49 minutes, and the mean length of hospital stay was 1.4 days. The most frequent complications of TEP laparoscopic repair of inguinal hernia were ecchymosis (32.85%), followed by wound pain (16.42%). Surgery related complications occurred in two cases (0.71%) of SSI and 13 cases (8.65%) of wound hematoma. No additional surgical treatment for complications were required. No mesh infection occurred in patients during the follow up period.
Conclusion: Non-prophylactic antibiotics for elective TEP laparoscopic repair of inguinal hernia appear to be acceptable. Randomized controlled trials of the efficiency of antibiotic therapy in SSI in patients with inguinal hernia should be conducted.

Keywords Laparoscopic surgical procedure, Inguinal hernia, Antibiotic prophylaxis, Hernia repair

  1. Deysine M. Postmesh herniorrhaphy infection control. Int Surg 2004;8:90-91.
  2. Stephenson BM. Complications of open groin hernia repair. Surg Clin North Am 2003;83:1255-1278.
    CrossRef
  3. Yerdel MA, Ak ı n EB, Dolalan S, et al. Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh. Ann Surg 2001;233:26-33.
    Pubmed KoreaMed CrossRef
  4. Kim SG, Park SH, Choi SY, Kim HS, Kim TH. Laparoscopic totally extraperitoneal hernia repair for inguinal hernia patients: results of 92 cases. J Korean Soc Endosc Laparosc Surg 2011;14:96-100.
  5. Cheek CM, Williams MH, Farndon JR. Trusses in the management of hernia today. Br J Surg 1995;82:1611-1613.
    Pubmed CrossRef
  6. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992:a modification of CDC definitions of surgical wound infections. Infect Control Ho sp Epidemiol 1992;13:606-608.
    CrossRef
  7. WHO (World Health Organization). Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva:World Health Organization; 1995.
  8. Patino JF, Garcia-Herreros LG, Zundel N. Inguinal hernia repair: the Nyhus posterior prep eritoneal operation. Surg Clin North Am 1998;78:1063-1074.
    CrossRef
  9. D’Amico DF, Parimbelli P, Ru ffolo C. Antibiotic prophylaxis in clean surgery: breast surgery and hernia repair. J Chemother 2001;13:108-111.
    Pubmed CrossRef
  10. Perez AR, Roxas MF, Hilvano SS. A randomized, double-blind, placebocontrolled trial to deter mine effectiveness of antibioti c prophylaxis for tensionfree mesh herniorrhaphy. J Am Coll Surg 2005;200:393-399.
    Pubmed CrossRef
  11. Tzovaras G, Delikoukos S, Ch ristodoulides M, et al. The role of antibiotic prophylaxis in elective tension-free mesh inguina l hernia repair: results of a single-centre prospective randomise d trial. Int J Clin Pract 2007;61:236-239.
    Pubmed CrossRef
  12. Celdr ? n A, Frieyro O, de la Pinta JC, et al. The role of antibiotic prophylaxis on wound infection after mesh repair under local anesthesia on an ambulatory basis. Hernia 2004;8:20-22. 13.Gupta R, Sinnett D, Carpenter R, Preece PE, Royle GT. Antibiotic prophylaxis for post-operative wound infection in clean elective breast surgery. Eur J Surg Oncol 2000;26:363-366.
    Pubmed CrossRef
  13. Delikoukos S, Tzovaras G, Liakou P, Mantzos F, Hatzitheofilo u C. Late-onset deep mesh infecti on after inguinal hernia repair. Hernia 2007;11:15-17.
    Pubmed CrossRef
  14. Corbitt JD Jr. Transabdominal preperitoneal herniorrhaphy. Surg Laparosc Endosc 1993;3:328-332.
    Pubmed
  15. Lewis RT, Weigand FM, Mamazza J, Lloyd-smith W, Tataryn D. Should antibiotic prophylaxis be used routinely in clean surgical procedures: a tentative yes. Surgery 1995;118:742-746.
    CrossRef
  16. Platt R. Antibiotic prophylaxis in clean surgery. New Horiz 1998;6:53-57.
  17. Knight R, Charbonneau P, Ratzer E, Zeren F, Haun W, Clark J. Prophylactic antibiotics are n ot indicated in clean general surgery cases. Am J Surg 2001;182:682-686.
    CrossRef
  18. Leaper DJ, Melling AG. Antibiotic prophylaxis in clean surgery: clean non-implant w ounds. J Chemother 2001;13:96-101.
    Pubmed CrossRef
  19. Kinirons B, Mimoz O, Lapendi LP, Naas T, Meunier JF, Nordmann P. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized. Anesthesiology 2001;94:239-244.
    Pubmed CrossRef
  20. Aufenacker TJ, van Geldere D, van Mesdag T, et al. The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh her nia repair of primary inguinal hernia. A multicenter double-b lind randomized controlled trial. Ann Surg 2004;240:955-961.
    Pubmed KoreaMed CrossRef
  21. Perez AR, Roxas MF, Hilvano SS. A randomized, doubleblind, placebo-controlled trial t o determine effectiveness of antibiotic prophylaxis for tension-free mesh herniorrhaphy. J Am Coll Surg 2005;200:393-397.
    Pubmed CrossRef
  22. Petersen S, Henke G, Freitag M, Faulhaber A, Ludwig K. Deep prosthesis infec tion in incisional hernia repair: predicti ve factors and clinical outcome. Eur J Surg 2001;167:453-457.
    Pubmed CrossRef

Article

Original Article

J Minim Invasive Surg 2012; 15(4): 156-160

Published online December 15, 2012 https://doi.org/10.7602/jmis.2012.15.4.156

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

전복막외 복강경 탈장 교정술 시행 시 예방적 항생제 미사용에 대한 전향적 분석

이영훈ㆍ하태경

한양대학교 의과대학 외과학교실

A Prospective Study of Non-Prophylatic Antibiotics for Totally Extraperitoneal Laparoscopic Repair of Inguinal Hernia

Young Hoon Lee, M.D., Tae Kyung Ha, M.D., Ph.D.

Department of Surgery, College of Medicine, Hanyang University, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: The role of prophylactic antibiotics in totally extraperitoneal (TEP) laparoscopic repair of inguinal hernia is unclear. This study was conducted to evaluate the effects of antibiotic therapy for surgical site infection (SSI) in post TEP laparoscopic repair of inguinal hernia.
Methods: We prospectively reviewed data collected from 280 patients with inguinal hernias who were treated by TEP laparoscopic repair between August 2008 and July 2012. None of the patients received prophylactic antibiotics. Patients with a history of recurrent hernias, immune suppressive disease or diabetes mellitus were excluded from the study.
Results: There were 265 male patients and 15 female patients aged 19 to 82 years. There were 240 indirect, 38 direct, and 2 pantaloon hernias. The mean operating time was 49 minutes, and the mean length of hospital stay was 1.4 days. The most frequent complications of TEP laparoscopic repair of inguinal hernia were ecchymosis (32.85%), followed by wound pain (16.42%). Surgery related complications occurred in two cases (0.71%) of SSI and 13 cases (8.65%) of wound hematoma. No additional surgical treatment for complications were required. No mesh infection occurred in patients during the follow up period.
Conclusion: Non-prophylactic antibiotics for elective TEP laparoscopic repair of inguinal hernia appear to be acceptable. Randomized controlled trials of the efficiency of antibiotic therapy in SSI in patients with inguinal hernia should be conducted.

Keywords: Laparoscopic surgical procedure, Inguinal hernia, Antibiotic prophylaxis, Hernia repair

References

  1. Deysine M. Postmesh herniorrhaphy infection control. Int Surg 2004;8:90-91.
  2. Stephenson BM. Complications of open groin hernia repair. Surg Clin North Am 2003;83:1255-1278.
    CrossRef
  3. Yerdel MA, Ak ı n EB, Dolalan S, et al. Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh. Ann Surg 2001;233:26-33.
    Pubmed KoreaMed CrossRef
  4. Kim SG, Park SH, Choi SY, Kim HS, Kim TH. Laparoscopic totally extraperitoneal hernia repair for inguinal hernia patients: results of 92 cases. J Korean Soc Endosc Laparosc Surg 2011;14:96-100.
  5. Cheek CM, Williams MH, Farndon JR. Trusses in the management of hernia today. Br J Surg 1995;82:1611-1613.
    Pubmed CrossRef
  6. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992:a modification of CDC definitions of surgical wound infections. Infect Control Ho sp Epidemiol 1992;13:606-608.
    CrossRef
  7. WHO (World Health Organization). Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva:World Health Organization; 1995.
  8. Patino JF, Garcia-Herreros LG, Zundel N. Inguinal hernia repair: the Nyhus posterior prep eritoneal operation. Surg Clin North Am 1998;78:1063-1074.
    CrossRef
  9. D’Amico DF, Parimbelli P, Ru ffolo C. Antibiotic prophylaxis in clean surgery: breast surgery and hernia repair. J Chemother 2001;13:108-111.
    Pubmed CrossRef
  10. Perez AR, Roxas MF, Hilvano SS. A randomized, double-blind, placebocontrolled trial to deter mine effectiveness of antibioti c prophylaxis for tensionfree mesh herniorrhaphy. J Am Coll Surg 2005;200:393-399.
    Pubmed CrossRef
  11. Tzovaras G, Delikoukos S, Ch ristodoulides M, et al. The role of antibiotic prophylaxis in elective tension-free mesh inguina l hernia repair: results of a single-centre prospective randomise d trial. Int J Clin Pract 2007;61:236-239.
    Pubmed CrossRef
  12. Celdr ? n A, Frieyro O, de la Pinta JC, et al. The role of antibiotic prophylaxis on wound infection after mesh repair under local anesthesia on an ambulatory basis. Hernia 2004;8:20-22. 13.Gupta R, Sinnett D, Carpenter R, Preece PE, Royle GT. Antibiotic prophylaxis for post-operative wound infection in clean elective breast surgery. Eur J Surg Oncol 2000;26:363-366.
    Pubmed CrossRef
  13. Delikoukos S, Tzovaras G, Liakou P, Mantzos F, Hatzitheofilo u C. Late-onset deep mesh infecti on after inguinal hernia repair. Hernia 2007;11:15-17.
    Pubmed CrossRef
  14. Corbitt JD Jr. Transabdominal preperitoneal herniorrhaphy. Surg Laparosc Endosc 1993;3:328-332.
    Pubmed
  15. Lewis RT, Weigand FM, Mamazza J, Lloyd-smith W, Tataryn D. Should antibiotic prophylaxis be used routinely in clean surgical procedures: a tentative yes. Surgery 1995;118:742-746.
    CrossRef
  16. Platt R. Antibiotic prophylaxis in clean surgery. New Horiz 1998;6:53-57.
  17. Knight R, Charbonneau P, Ratzer E, Zeren F, Haun W, Clark J. Prophylactic antibiotics are n ot indicated in clean general surgery cases. Am J Surg 2001;182:682-686.
    CrossRef
  18. Leaper DJ, Melling AG. Antibiotic prophylaxis in clean surgery: clean non-implant w ounds. J Chemother 2001;13:96-101.
    Pubmed CrossRef
  19. Kinirons B, Mimoz O, Lapendi LP, Naas T, Meunier JF, Nordmann P. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized. Anesthesiology 2001;94:239-244.
    Pubmed CrossRef
  20. Aufenacker TJ, van Geldere D, van Mesdag T, et al. The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh her nia repair of primary inguinal hernia. A multicenter double-b lind randomized controlled trial. Ann Surg 2004;240:955-961.
    Pubmed KoreaMed CrossRef
  21. Perez AR, Roxas MF, Hilvano SS. A randomized, doubleblind, placebo-controlled trial t o determine effectiveness of antibiotic prophylaxis for tension-free mesh herniorrhaphy. J Am Coll Surg 2005;200:393-397.
    Pubmed CrossRef
  22. Petersen S, Henke G, Freitag M, Faulhaber A, Ludwig K. Deep prosthesis infec tion in incisional hernia repair: predicti ve factors and clinical outcome. Eur J Surg 2001;167:453-457.
    Pubmed CrossRef

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