Is antibiotic prophylaxis mandatory in laparoscopic incisional hernia repair? Data from the herniamed registry

Philipp Kirchhoff; Henry Hoffmann; Ferdinand Köckerling; Daniela Adolf; Reinhard Bittner; Ralph F Staerkle

doi:10.1016/j.ijsu.2018.08.012

Is antibiotic prophylaxis mandatory in laparoscopic incisional hernia repair? Data from the herniamed registry

Int J Surg. 2018 Oct:58:31-36. doi: 10.1016/j.ijsu.2018.08.012. Epub 2018 Sep 10.

Authors

Philipp Kirchhoff¹, Henry Hoffmann¹, Ferdinand Köckerling², Daniela Adolf³, Reinhard Bittner⁴, Ralph F Staerkle⁵

Affiliations

¹ Department of Surgery, Clinic for Visceral Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
² Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585 Berlin, Germany.
³ StatConsult GmbH, Halberstädter Straße 40 a, 39112 Magdeburg, Germany.
⁴ Winghofer Medicum Hernia Center, Winghofer Straße 42, 72108 Rottenburg Am Neckar, Germany.
⁵ Department of Surgery, Clinic for Visceral Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland. Electronic address: ralph.staerkle@usb.ch.

PMID: 30213763
DOI: 10.1016/j.ijsu.2018.08.012

Abstract

Background: Several meta-analyses showed that laparoscopic incisional hernia repair is associated with lower surgical site infection (SSI) rates compared to open repair. However, the efficiency of antibiotic prophylaxis (AP) in laparoscopic incisional hernia repair alone is unknown and needs evaluation. Due to increasing antimicrobial resistance, a major global health care problem, AP needs to be critically evaluated. The aim of this study was to investigate the impact of AP on the rate of SSI and complication-related reoperations in patients undergoing laparoscopic incisional hernia repair.

Materials and methods: Prospectively documented data from the Herniamed Hernia Registry from 2009 to 2017 were retrospectively analysed. Multivariable analyses were used to study the influence of AP as well as further patient and surgery-related risk factors on SSI and complication-related reoperation rates. This was verified in a sensitivity analysis using propensity-score matching.

Results: In the analysed time period 13'513 patients undergoing elective laparoscopic incisional hernia repair were recorded, of which 14.4% (n = 1949) did not receive AP. The overall SSI rate showed no significant difference when directly comparing patients with (0.74%) and without AP (0.97%; p = 0.262). In the multivariable analysis the presence of patient related risk factors (p = 0.015) and defect size >10 cm (p = 0.035) significantly increased the rates of SSI and complication-related reoperations. The propensity-score matching analysis verified that SSI rates are not significantly different between the two groups (p = 0.265).

Conclusions: In cases of laparoscopic incisional hernia repair in patients without risk factors and moderate hernia diameter (<10 cm), routine administration of AP in laparoscopic incisional hernia repair does not seem to be justified.

Keywords: Antibiotic prophylaxis; Incisional hernia; Laparoscopic hernia repair; Risk factors; Surgical site infection.

MeSH terms

Adult
Aged
Antibiotic Prophylaxis*
Elective Surgical Procedures / methods*
Female
Humans
Incisional Hernia / surgery*
Laparoscopy / methods*
Male
Middle Aged
Propensity Score
Prospective Studies
Retrospective Studies
Surgical Wound Infection / prevention & control*