The effectiveness of i.v. cefuroxime prophylaxis of surgical site infection after elective inguinal hernia repair with mesh: A retrospective observational study

Abstract Background Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months. Material A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542). Conclusion The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified.

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A prospective comparative observational study of clinical efficacy of isobaric ropivacaine 0.75% with of isobaric bupivacaine 0.5% intrathecally in elective inguinal hernia repair surgeries

Anesthesia Essays and Researches ◽

10.4103/aer.aer_105_17 ◽

2017 ◽

Vol 11 (3) ◽

pp. 561

Author(s):

ShivamBipin Parekh ◽

SuchitaShailesh Parikh ◽

Harsha Patel ◽

Malini Mehta

Keyword(s):

Inguinal Hernia ◽

Observational Study ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Clinical Efficacy

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Effect of single dose pre-operative antibiotic prophylaxis versus conventional antibiotic therapy in patients undergoing lichtenstein tension free mesh repair

International Surgery Journal ◽

10.18203/2349-2902.isj20170224 ◽

2017 ◽

Vol 4 (2) ◽

pp. 738

Author(s):

Madhu B. S. ◽

Shashi Kumar H. B. ◽

Naveen Kumar Reddy M. ◽

Abilash V. Reddy ◽

Sangeetha Kalabhairav

Keyword(s):

Single Dose ◽

Inguinal Hernia ◽

Side Effects ◽

Hernia Repair ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Mesh Repair ◽

Control Group ◽

Site Infection ◽

Tension Free

Background: Rational use of antibiotic is important as injudicious use can adversely affect the patient, cause emergence of antibiotic resistance and increase the cost of health care. The efficacy of antibiotic prophylaxis in preventing surgical site infection in patients undergoing Lichtenstein tension free inguinal hernia repair still remains controversial.Methods: A randomized controlled trial was conducted in patients undergoing lichtenstein tension free inguinal hernia repair between January 2015 to June 2016, and the results were compared with the control group in whom, conventional antibiotics were given for 7 days . All patients in study group undergoing surgery were given 400 mg parenteral ciprofloxacin 30 min prior to surgery. In the control group, the patients were given 2 days parenteral ciprofloxacin 400 mg twice a day and the next 5 days the same antibiotics were given in oral route, after surgery. Total 100 patients were randomized to 50 each group. The outcome in terms of duration of surgery, surgical site infection, cost and antibiotic side effects were then compared.Results: The duration of the hospital stay, cost and side effects are significantly higher in the control group patients. Antibiotic side effects (P < 0.05) were high for control group. The infection rate was same in both the groups. There was no significant difference in terms of infection rate among two groups.Conclusions: This study concludes that prophylactic single-dose antibiotic is effective in preventing surgical site infection and is cost-effective in patients undergoing lichtenstein tension free mesh repair.

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Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm11020321 ◽

2022 ◽

Vol 11 (2) ◽

pp. 321

Author(s):

Fu-Huan Huang ◽

Po-Lung Cheng ◽

Wen-Hsuan Hou ◽

Yih-Cherng Duh

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Surgical Site Infection ◽

Laparoscopic Hernia Repair ◽

Meta Analysis ◽

Operation Time ◽

Site Infection ◽

Pediatric Inguinal Hernia ◽

Extraperitoneal Approach ◽

Open Hernia Repair

Objective: This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. Summary Background Data: Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. Results: Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: −11.90 min, 95% CI: −16.63 to −7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. Conclusions: LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.

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