Meta-analysis of the effectiveness of prophylactic antibiotics in the prevention of postoperative complications after tension-free hernioplasty

Tension-free hernioplasty is rapidly becoming the most popular technique for repairing inguinal hernias.1–6 More than 80% of abdominal wall hernias occur in the groin, and most are repaired with prosthetic mesh. Incision infection is the most frequent complication in tension-free hernioplasty.7 Some studies have identified risk factors for incision infection: sex (greater risk among women), age (> 70 yr), comorbidity, duration of surgery, and routine use of drainage and prostheses.8–11 Incision infection is associated with a longer length of stay in hospital, increased costs and a decrease in quality of life.12,13 It remains uncertain whether antibiotic prophylaxis is indicated to prevent postoperative incision infection after mesh repair of inguinal hernias. The incidence of infection after inguinal hernia repair has been reported to vary from 0% to 9%.14 When a foreign body, such as a polypropylene mesh, is used, prevention of an incision infection is more important. A 2004 Cochrane review15 concluded that antibiotic prophylaxis for elective inguinal hernia repair could not be firmly recommended or discarded because the number of patients in randomized controlled trials (RCTs) was limited. However, new RCTs involving patients having tension-free hernioplasty have been published in recent years, increasing the number of patients evaluated. We conducted a new meta-analysis to assess the effectiveness of antibiotic prophylaxis in preventing postoperative complications after tension-free hernioplasty.