Comparative study of use of prophylactic antibiotic for elective hernia repair with use of prosthetic material: observational study in a tertiary care institute

Philip Umman, Joyal Jose, Althaf Ahmed, Jeenu Xavier


Background: There is widespread misuse of antibiotics leading to increasing reports of drug resistance. This has been highlighted by the World Health Organization (WHO). Wrong antibiotics are chosen, used when not indicated and used in dosages or patterns that are not recommended. We tried to analyse the pattern of antibiotic use for elective hernia repair using polypropylene mesh among the surgical units in our hospital for elective clean cases. The antibiotic use pattern and the incidence of surgical site infections were to be analysed to create uniform policies for antibiotic use across the institution.

Methods: We looked at the case records of patients undergoing elective hernia repair in one month in our institution under different surgeons. Inguinal, umbilical and simple incisional hernias were taken into study. Both open and laparoscopic hernia repairs were included in the study. Emergency hernia repairs were excluded. We looked at the type of prophylactic antibiotic given, the dose and approximate time difference between injection and incision time, whether patient received further doses of intravenous or oral antibiotic. If further doses were given, we also looked for reasons if documented. These cases were followed for one month to see if there was any difference in the incidence of surgical site infections.

Results: There were thirty-one cases, of which 16 received only a single dose of prophylactic antibiotic while 15 received more than one dose of antibiotic. Only one patient in the prophylactic antibiotic only group developed a culture positive wound infection. There was seroma formation in two patients.

Conclusions: There was no evidence of higher incidence of wound infection in patients receiving only prophylactic antibiotic. There is a need for developing institution specific policies on antibiotic use. This will reduce the treatment costs and also avoid the development of antibiotic resistance in the society.


Antibiotic prophylaxis, Clean surgery, Prosthetic material

Full Text:



Treatment Guidelines for Antimicrobial Use in Common Syndromes. Indian Council of Medical Research, Department of Health Research, New Delhi, India, 2017.

Report of an Ad Hoc Committee of the Committee on Trauma, Division Medical Sciences, NAS-NRC: Postoperative Wound Infections: The Influence of Ultraviolet Irradiation of the Operating Room and of Various Other Factors. Ann. Surg. 1964;160:1-192.

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections. A modification of CDC definitions of surgical wound infections. Infection Control Hosp Epidemiol. 1992;13:606-8.

Inoue H, Minghui R. Bulletin of the World Health Organization. 2017;95:242.

Zamkowski MT, Makarewicz W, Ropel J, Bobowicz M, Kąkol M, Śmietański M. Antibiotic prophylaxis in open inguinal hernia repair: a literature review and summary of current knowledge. Videosurgery and Other Miniinvasive Techniques. 2016;11(3):127.

Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009 Aug; 13(4):343-403.

Shankar VG, Srinivasan K, Sistla SC, Jagdish S. Prophylactic antibiotics in open mesh repair of inguinal hernia - a randomized controlled trial. Int J Surg. 2010;8(6):444-7.

Mazaki T, Mado K, Masuda H, Shiono M, Tochikura N, Kaburagi M. A randomized trial of antibiotic prophylaxis for the prevention of surgical site infection after open mesh-plug hernia repair. Am J Surg. 2014 Apr;207(4):476-84.

Sanchez-Manuel FJ, Lozano-Garcia J, Seco-Gil JL. Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev. 2012;2:003769.

Li JF, Lai DD, Zhang XD, Zhang AM, Sun KX, Luo HG, et al. Meta-analysis of the effectiveness of prophylactic antibiotics in the prevention of postoperative complications after tension-free hernioplasty. Canadian J of Su. 2012 Feb;55(1):27.

Ergul Z, Akinci M, Ugurlu C, Kulacoglu H, Yilmaz KB. Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center. Hernia. 2012 Apr 1;16(2):145-51.

NICE Guidance - Surgical site infections: prevention and treatment, 2017. Available at Accessed 11 October 2017.

SIGN. Antibiotic prophylaxis in surgery. Available at Accessed 11 October 2017.

Aiken AM, Haddow JB, Symons NR, Kaptanis S, Katz-Summercorn AC, Debnath D, et al. Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey. Hernia. 2013 Oct 1;17(5):657-64.

Joint External Evaluation of IHR Core Capacities of Albania. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.