Local antibiotics are equivalent to intravenous antibiotics in the prevention of superficial wound infection in inguinal hernioplasty

Abstract

Background: Antibiotic prophylaxis for inguinal hernioplasty is still practiced in many hospitals to prevent consequences of infected mesh, mesh removal and hernia recurrence. The common route of administration is intravenous. However this method can be associated with systemic side effects. Alternatively, locally applied antibiotics have been used and proven to significantly reduce the infection rate after inguinal hernioplasty.

Methods: This was a single blinded prospective randomised trial with a primary aim to compare the superficial surgical wound infection (SSSI) rate between locally applied gentamicin against systemic gentamicin in elective unilateral inguinal hernioplasty. All patients underwent the Lichtenstein tensionfree repair. The secondary aim was to identify risk factors associated with the development of SSSI.

Results: A total of 202 patients were recruited. There were fourteen SSSI, seven in each arm. The overall SSSI rate was 6.9%. There was no significant difference between the locally applied versus intravenous administered antibiotics (p = 0.97). Factors found to contribute to SSSI were diabetes mellitus (p = 0.006), age 6070 years (p = 0.023), adhesions (p = 0.001), duration of surgery > 90 minutes (p = 0.048), duration of hernia > 24 months (p = 0.001) and the presence of haematoma (p = 0.001).

Conclusion: Locally applied gentamicin is equivalent to intravenous gentamicin in preventing SSSI post primary inguinal hernioplasty.