Title: Efficiency of Single Dose Antibiotic Prophylaxis in Inguinal Hernioplasty

Authors: Pavan BK, Bhaskaran A, Asadulla Baig, Akarsh YG, Karthik Hareen TVK

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i7.141

Abstract

Introduction and objectives: Surgical site infection (SSI) is the most frequent complication in inguinal hernioplasty.SSI is related with an increase in length of stay and costs and a decrease in quality of life. Use of antibiotics in Lichtenstein’s hernia repair is still debatable in a rural set up. Another subject in rural setup that must be addressed in antibiotic prophylaxis is cost-effectiveness. In these cases, the costs of antibiotic administration must be carefully evaluated against the potentials benefits.

Materials and Methods: The study was conducted out between December 2014 to October 2016 on 60 patients. The patients were assigned alternately into 2 groups. Cases in Group A received single dose of pre-operative antibiotic 30 minutes before surgery and cases in group B received multiple doses peri-operatively. The patients were then monitored post operatively from the second day onwards for SSI. The data was collected and statistics done using the Chi square/Fischer exact test to look for significant difference in the rate off SSIs in both the groups and also to find out if it was cost effective.

Results and Inferences: Incidence of SSI in group A was 3.33% (1 in 30). Incidence of SSI in group B was 6.6%( 2 in 30).Incidence of SSI though higher in group B than group A was not statistically significant when Fischer exact test was applied. The cost of antibiotic per patient in group A was Rs.32 while that in group B was between a minimum of Rs.192 in patients without SSI to a maximum of Rs.340 with SSI. The difference in cost of antibiotic in both groups was statistically significant.

Conclusion: Single dose antibiotic prophylaxis was therapeutically efficient as well as cost effective in comparison with multiple doses of perioperative antibiotics usage for the prevention of surgical site infection in uncomplicated elective cases of Lichtenstein’s hernioplasty.

Keywords: inguinal hernia; lichtenstein’s repair; SSI; antibiotic; prophylaxis.

References

1.      Bendavid R. Complications of groin hernia surgery. Surg Clin North Am. 1998;78:1089–1103

2.      Abo RE. Perioperative antibiotic prophylaxis in abdominal surgery for hernia repair: retrospective study of 1,524 consecutive patients. J Chemother. 1998;10: 248–253.

3.      Taylor EW, Duffy K, Lee K, et al. Surgical site infection after groin hernia repair. Br J Surg. 2004;91:105–111.

4.      Deysine M. Pathophysiology, prevention, and management of prosthetic infections in hernia surgery.SurgClin North Am1998;78:1105–1115. 

5.      Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997 ; 1 : 15–21.

6.      Barie PS. Modern surgical antibiotic prophylaxis and therapy–less is more. Surg Infect (Larchmt). 2000; 1:23–29.

7.      Patino JF, Garcia-Herreros LG, Zundel N. Inguinal hernia repair: the Nyhus posterior preperitoneal operation. SurgClin North Am. 1998;78:1063–1074.

8.      Weed HG. Antimicrobial prophylaxis in the surgical patient. Med Clin North Am. 2003;87:59–75]

9.      Sanchez-Manuel FJ, Seco-Gil JL. Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev. 2004;CD003769

10.  Lewis RT, Weigand FM, Mamazza J, et al. Should antibiotic prophylaxis be used routinely in clean surgical procedures: a tentative yes. Surgery. 1995;118:742–746. 

11.  Platt R. Antibiotic prophylaxis in clean surgery: does it work? Should it be used if it does? New Horiz. 1998;6 (suppl):53–57.

12.  D'Amico DF, Parimbelli P, Ruffolo C. Antibiotic prophylaxis in clean surgery: breast surgery and hernia repair. J Chemother. 2001 ; 13:108–111. 

13.  Gupta R, Sinnett D, Carpenter R, et al. Antibiotic prophylaxis for post-operative wound infection in clean elective breast surgery. Eur J SurgOncol. 2000;26:363–366. 

14.  Cheek CM, Williams MH, Farndon JR. Trusses in the management of hernia today. Br J Surg. 1995;82:1611–1613.

15.  Aufenacker JT,Geldere D,Mesdag T.The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh repair of primary inguinal hernia .Ann Surg 2004;240:955-961.

16.  Najam-ul-Haq R,Chaudhry IA,Khan BA,Afzal M.Groin prophylaxis following hernioplasty without antibiotic prophylaxis-a review of 100 cases.Pak J Med Sci 2006;4:416-419.

17.  Delikoukos S,Tzovaras G,Liakou P,Mantzos F,Hatzitheofilou C.Late onset deep mesh infection after inguinal hernia repair.Hernia 2007;11:15-17.

18.  Sanabria A,Doniguez C L,Valdivieso E,Gomez G. Prophylactic antibiotics for mesh inguinal hernioplasty.AnnSurg 2007; 245: 392-396.

19.  Thakur L,Uphadhyay S,Peters J N.Prophylactic antibiotic usage in patients undergoing inguinal mesh hernioplasty-A clinical study.IJS;72:240-242.

Corresponding Author

Karthik Hareen TVK

Post graduate, Dept of General Surgery,

Sri Devraj Urs Medical College, Kolar