Perez Anthony R, Roxas Manuel F, Hilvano Serafin S
Department of Surgery, University of the Philippines College of Medicine and Philippine General Hospital, Manila, Philippines.
J Am Coll Surg. 2005 Mar;200(3):393-7; discussion 397-8. doi: 10.1016/j.jamcollsurg.2004.10.037.
In recent years, use of prosthetic material for inguinal hernia repair has increased dramatically. Tension-free repairs have gained popularity not only for recurrent or complicated hernias, but for primary hernia repairs as well. Although routine use of prophylactic antibiotics is not recommended in the Philippines for open nonimplant herniorrhaphy, there is little direct clinical evidence on which to base recommendations when implantable mesh is used.
We conducted a prospective, randomized, double-blind, placebo-controlled trial comparing wound infection rates in 360 patients (180 received prophylactic antibiotics, 180 received a placebo) undergoing primary inguinal hernia repair electively using polypropylene mesh. Age, gender, American Society of Anesthesiologists class, type of hernia, type of anesthesia, and duration of operation were recorded. Infections were evaluated 1 week, 2 weeks, and 1 month after operation by an independent surgeon. All complications were recorded. Results were assessed using chi-square, Fisher's exact test, and Student's t-tests as appropriate.
Groups were well matched for all preoperative variables studied, including comorbid conditions. Six patients from the antibiotic group and four from the placebo group failed to followup after the second week. Superficial surgical site infection developed in 3 patients (1.7%) from the antibiotic group and 6 (3.3%) from the placebo group (p = 0.50). One from each group developed deep surgical site infection. Both patients were readmitted and underwent repeated debridement, which eventually resulted in graft loss.
Preoperative administration of single-dose antibiotic for tension-free inguinal mesh herniorrhaphy did not markedly decrease risk of wound infection in this patient population. Our results do not support use of antibiotic prophylaxis for tension-free mesh herniorrhaphy.
近年来，用于腹股沟疝修补的人工材料使用量急剧增加。无张力修补不仅在复发性或复杂性疝修补中受到欢迎，在原发性疝修补中也越来越普遍。尽管在菲律宾，对于开放性非植入性疝修补术不建议常规使用预防性抗生素，但在使用可植入补片时，几乎没有直接的临床证据作为推荐的依据。
我们进行了一项前瞻性、随机、双盲、安慰剂对照试验，比较了360例行择期聚丙烯补片原发性腹股沟疝修补术患者（180例接受预防性抗生素治疗，180例接受安慰剂治疗）的伤口感染率。记录患者的年龄、性别、美国麻醉医师协会分级、疝的类型、麻醉方式和手术时长。术后1周、2周和1个月由一名独立的外科医生评估感染情况。记录所有并发症。根据情况使用卡方检验、Fisher精确检验和学生t检验评估结果。
两组在所有研究的术前变量（包括合并症）方面匹配良好。抗生素组有6例患者，安慰剂组有4例患者在第二周后失访。抗生素组有3例患者（1.7%）发生浅表手术部位感染，安慰剂组有6例患者（3.3%）发生浅表手术部位感染（p = 0.50）。每组各有1例患者发生深部手术部位感染。两名患者均再次入院并接受反复清创，最终导致补片丢失。
对于无张力腹股沟补片疝修补术，术前给予单剂量抗生素并不能显著降低该患者群体的伤口感染风险。我们的结果不支持在无张力补片疝修补术中使用抗生素预防。
