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Sartelli M, Coccolini F, Labricciosa FM, Al Omari AH, Bains L, Baraket O, Catarci M, Cui Y, Ferreres AR, Gkiokas G, Gomes CA, Hodonou AM, Isik A, Litvin A, Lohsiriwat V, Kotecha V, Khokha V, Kryvoruchko IA, Machain GM, O’Connor DB, Olaoye I, Al-Omari JAK, Pasculli A, Petrone P, Rickard J, Sall I, Sawyer RG, Téllez-Almenares O, Catena F, Siquini W. Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle. Antibiotics (Basel) 2024; 13:100. [PMID: 38275329 PMCID: PMC10812782 DOI: 10.3390/antibiotics13010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
In the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical site infections is surgical antibiotic prophylaxis (SAP). This narrative review aims to present a bundle for the correct SAP administration and evaluate the evidence supporting it. Surgical site infection (SSI) prevention guidelines published by the WHO, CDC, NICE, and SHEA/IDSA/APIC/AHA, and the clinical practice guidelines for SAP by ASHP/IDSA/SIS/SHEA, were reviewed. Subsequently, comprehensive searches were also conducted using the PubMed®/MEDLINE and Google Scholar databases, in order to identify further supporting evidence-based documentation. The bundle includes five different measures that may affect proper SAP administration. The measures included may be easily implemented in all hospitals worldwide and are based on minimal drug pharmacokinetics and pharmacodynamics knowledge, which all surgeons should know. Antibiotics for SAP should be prescribed for surgical procedures at high risk for SSIs, such as clean-contaminated and contaminated surgical procedures or for clean surgical procedures where SSIs, even if unlikely, may have devastating consequences, such as in procedures with prosthetic implants. SAP should generally be administered within 60 min before the surgical incision for most antibiotics (including cefazolin). SAP redosing is indicated for surgical procedures exceeding two antibiotic half-lives or for procedures significantly associated with blood loss. In principle, SAP should be discontinued after the surgical procedure. Hospital-based antimicrobial stewardship programmes can optimise the treatment of infections and reduce adverse events associated with antibiotics. In the context of a collaborative and interdisciplinary approach, it is essential to encourage an institutional safety culture in which surgeons are persuaded, rather than compelled, to respect antibiotic prescribing practices. In that context, the proposed bundle contains a set of evidence-based interventions for SAP administration. It is easy to apply, promotes collaboration, and includes measures that can be adequately followed and evaluated in all hospitals worldwide.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, 62100 Macerata, Italy;
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Unit, Pisa University Hospital, 56124 Pisa, Italy;
| | | | - AbdelKarim. H. Al Omari
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Lovenish Bains
- Department of General Surgery, Maulana Azad Medical College, New Delhi 110002, India;
| | - Oussama Baraket
- Department of General Surgery, Bizerte Hospital, Bizerte 7000, Tunisia;
| | - Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, 00157 Rome, Italy;
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300052, China;
| | - Alberto R. Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires 1428, Argentina;
| | - George Gkiokas
- Department of Surgery, Medical School, “Aretaieio” Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Carlos Augusto Gomes
- Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora 25520, Brazil;
| | - Adrien M. Hodonou
- Department of Surgery, Faculty of Medicine, University of Parakou, Parakou 03 BP 10, Benin;
| | - Arda Isik
- Department of Surgery, Istanbul Medeniyet University, Istanbul 34000, Turkey;
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, 246000 Gomel, Belarus;
| | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Vihar Kotecha
- Department of General Surgery, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vladimir Khokha
- General Surgery Unit, Podhalanski Specialized Hospital, 34-400 Nowy Targ, Poland;
| | - Igor A. Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, 61000 Kharkiv, Ukraine;
| | - Gustavo M. Machain
- Department of Surgery, Universidad Nacional de Asuncion, San Lorenzo 1055, Paraguay;
| | - Donal B. O’Connor
- Department of Surgery, School of Medicine, Trinity College, D02 PN40 Dublin, Ireland;
| | - Iyiade Olaoye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin 240101, Nigeria;
| | - Jamal A. K. Al-Omari
- Medical College, Al-Balqa Applied University, Al-Hussein Hospital, Zarqa 13313, Jordan;
| | - Alessandro Pasculli
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Unit of Academic General Surgery “V. Bonomo”, University of Bari “A. Moro”, 70125 Bari, Italy;
| | - Patrizio Petrone
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital—Long Island, Mineola, NY 11501, USA;
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Dakar 3006, Senegal;
| | - Robert G. Sawyer
- Department of Surgery, School of Medicine, Western Michigan University, Kalamazoo, MI 49008, USA;
| | - Orlando Téllez-Almenares
- General Surgery Department of Saturnino Lora Provincial Hospital, University of Medical Sciences of Santiago de Cuba,
26P2+J7X, Santiago de Cuba 90100, Cuba;
| | - Fausto Catena
- Department of Surgery, “Bufalini” Hospital, 47521 Cesena, Italy;
| | - Walter Siquini
- Department of Surgery, Macerata Hospital, 62100 Macerata, Italy;
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Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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Sartelli M, Boermeester MA, Cainzos M, Coccolini F, de Jonge SW, Rasa K, Dellinger EP, McNamara DA, Fry DE, Cui Y, Delibegovic S, Demetrashvili Z, De Simone B, Gkiokas G, Hardcastle TC, Itani KMF, Isik A, Labricciosa FM, Lohsiriwat V, Marwah S, Pintar T, Rickard J, Shelat VG, Catena F, Barie PS. Six Long-Standing Questions about Antibiotic Prophylaxis in Surgery. Antibiotics (Basel) 2023; 12:antibiotics12050908. [PMID: 37237811 DOI: 10.3390/antibiotics12050908] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.
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Affiliation(s)
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Miguel Cainzos
- Department of Surgery, Hospital Clínico Universitario, 15706 Santiago de Compostela, Spain
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, 55126 Pisa, Italy
| | - Stijn W de Jonge
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, 41200 Kocaeli, Turkey
| | | | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, D09V2N0 Dublin, Ireland
| | - Donald E Fry
- Department of Surgery, Northwestern University, Chicago, IL 60208, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300100, China
| | - Samir Delibegovic
- Department of Surgery, University Clinical Center of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi 0162, Georgia
| | - Belinda De Simone
- Department of Emergency and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy/Saint Germain en Laye, 78300 Poissy CEDEX, France
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Timothy C Hardcastle
- Department of Surgery, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Mayville 4058, South Africa
| | - Kamal M F Itani
- Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, MA 02118, USA
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, 34700 Istanbul, Turkey
| | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sanjay Marwah
- Department of Surgery, BDS Post-Graduate Institute of Medical Sciences, Rohtak 124001, India
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Vishal G Shelat
- Department of Hepato-Pancreatic-Biliary Surgery, Tan Tok Seng Hospital, Singapore 308433, Singapore
| | - Fausto Catena
- Department of Surgery, "Bufalini" Hospital, 47023 Cesena, Italy
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, E. Northport, New York, NY 11731, USA
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Jain A, Mahakalkar C, Jajoo S, Aravind Kumar C. Mesh Antibioma: A New Entity in the Presentation of Late-Onset Mesh Infection. Cureus 2023; 15:e36144. [PMID: 37065419 PMCID: PMC10101185 DOI: 10.7759/cureus.36144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Antibioma is a tough-walled abscess, which usually forms as a sequela of inadequate or lack of pus drainage during infection and inappropriate use of antibiotics by the patient. In this case report, we present a case of the development of antibioma due to infected polypropylene mesh used in umbilical hernia repair 10 years ago in a 59-year-old obese male. He had a history of umbilical and right inguinal hernioplasty 10 years back. Intraoperatively, we found antibioma whose wall was made up of fibrous mesh and the center was filled with pus and nonfibrous mesh remnants. The pus was found to be sterile, and the wall was made up of fibromuscular adipose tissue with chronic inflammatory cells around it. This is a very rare presentation of umbilical site deep mesh infection as it had no signs of acute inflammation, neither pain nor any pus discharge. We conclude that the possible explanation for the formation of antibioma and its very delayed presentation could be due to mesh infolding and seroma/hematoma formation during previous surgery may have led to the formation of abscess and thick fibrous wall without any fistulous tract and other complications of deep mesh infection.
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Ng K, Goddard K. Extremely Late-Onset Deep Infection Post-inguinal Hernia Repair After Panendoscopy. Cureus 2022; 14:e22169. [PMID: 35308762 PMCID: PMC8923242 DOI: 10.7759/cureus.22169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/03/2022] Open
Abstract
Mesh infection after hernia repair is a well-known complication, which can have morbid consequences. This report presents a case of a gentleman with mesh infection many years after initial surgery, potentially from bacterial translocation post-colonoscopy, and describes his successful treatment. This case emphasizes the need to consider mesh infection regardless of time from surgery to presentation.
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Zhang J, Hu Z, Lin X, Chen B. Late-Onset Ileocutaneous Fistula Eight Years After Plug Repair With Polypropylene Mesh: A Case Report. Front Surg 2021; 8:785087. [PMID: 34869573 PMCID: PMC8634260 DOI: 10.3389/fsurg.2021.785087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: As one of the short-term complications after inguinal hernia repair, mesh infection frequently occurs but rarely leads to ileocutaneous fistula. We present a rare case of ileocutaneous fistula 8 years after inguinal hernia plug repair with polypropylene mesh. Case Presentation: The patient was a 67-year-old male who underwent a plug repair with polypropylene mesh of the right inguinal hernia. Eight years after the primary repair, skin ulceration with pus presented in the right groin area, and the final diagnosis was enterocutaneous fistula. According to laparoscopic exploration, the ileum below the fistula closely adhered to the abdominal wall. After gently separating the bowel loop, a defect area of about 2 × 3 cm was observed on the surface of the ileum. In laparotomy, the plug was found embedded in the ileum and then was completely removed, and an ileum side-to-side anastomosis was performed. The patient was discharged 2 weeks after the surgery, and follow-up at the sixth month revealed complete healing of the wound and no evidence of hernia recurrence. Conclusion: Late-onset ileocutaneous fistula should be considered in the differential diagnosis in patients who present inflammation and abscess formation after hernia repair. Besides, for patients with suspected intestinal fistula after hernia repair, laparoscopic exploration should be given priority, and the mesh removal approach should be tailored according to the results of laparoscopic exploration.
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Affiliation(s)
- Jiankang Zhang
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Zeming Hu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Lin
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Bin Chen
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Al Riyees L, Al Madani W, Firwana N, Balkhy HH, Ferwana M, Alkhudhayri A. Antibiotic Prophylaxis against Surgical Site Infection after Open Hernia Surgery: A Systematic Review and Meta-Analysis. Eur Surg Res 2021; 62:121-133. [PMID: 34404046 DOI: 10.1159/000517404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 05/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The role of antibiotic prophylaxis (AP) in the prevention of surgical site infection (SSI) after hernia repair is debated. We conducted this systematic review and meta-analysis to assess the evidence on the value of prophylactic antibiotics in reducing the risks of SSI after open hernia surgery. METHODS We ran an online and manual search to identify relevant randomized controlled trials that compared prophylactic antibiotics to nonantibiotic controls in patients undergoing open surgical hernia repair. Data on SSI risk were extracted and pooled as risk ratios (RRs) with 95% confidence intervals (95% CIs), using RevMan software. We further used the Cochrane risk of bias tool and GRADE assessment to evaluate the quality of generated evidence. RESULTS Twenty-nine studies (N = 8,616 patients) were included in the current analysis. Antibiotic prophylaxis reduced the risk of SSI in open hernia repair patients (RR = 0.65, 95% CI = 0.53, 0.79). Subgroup analysis showed a significant benefit for antibiotics in mesh repair patients (RR = 0.60, 95% CI = 0.48, 0.76) yet no significant difference in SSI risk after herniorrhaphy (RR = 0.86, 95% CI = 0.54, 1.36). In addition, AP was associated with a significant reduction in superficial SSI risk (RR = 0.56, 95% CI = 0.43, 0.72) but not deep SSI (RR = 0.70, 95% CI = 0.30, 1.62). Further analysis showed a significant reduction in SSI risk with amoxicillin/clavulanic acid and cefazolin but not with cefuroxime. CONCLUSION The present meta-analysis suggests that AP is beneficial prior to open mesh hernia repair. However, the quality of evidence was low, and further well-designed trials are needed.
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Affiliation(s)
- Lolwah Al Riyees
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Consultant of General Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Wedad Al Madani
- Senior Epidemiologist, National Center for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Saudi Arabia
| | - Nistren Firwana
- Executive Master of Health Informatics, University of Toronto, Toronto, Ontario, Canada
| | | | - Mazen Ferwana
- Professor of Family Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Co-director, National and Gulf Center for Evidence- Based Health Practice, Riyadh, Saudi Arabia.,Consultant, Family Medicine and Primary Healthcare Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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8
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Reply to the Letter 'Reflections on the consensus document on antibiotic prophylaxis in surgery' about to the article 'Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery'. Cir Esp 2021; 99:554-556. [PMID: 34244121 DOI: 10.1016/j.cireng.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 11/22/2022]
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9
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Badia JM, Balibrea JM, Del Toro López MD. Reply to the Letter 'Reflections on the consensus document on antibiotic prophylaxis in surgery' about to the article 'Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery'. Cir Esp 2021. [PMID: 34116829 DOI: 10.1016/j.ciresp.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Josep M Badia
- Servicio de Cirugía General y Digestiva, Hospital General de Granollers, Universitat Internacional de Catalunya, Catalunya, España.
| | - José M Balibrea
- Servicio de Cirugía General y Digestiva, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - María Dolores Del Toro López
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Universitat de Sevilla, Sevilla, España
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Gachabayov M, Latifi R. Different etiopathogeneses in early-onset and late-onset inguinal hernia mesh infections in a prospectively evaluated cohort. Acta Chir Belg 2021; 121:164-169. [PMID: 31690215 DOI: 10.1080/00015458.2019.1689648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Inguinal hernia mesh infection (IHMI) is a rare but a significant problem. The aim of this study was to determine whether etiopathogeneses of early-onset and late-onset IHMIs differ in terms of the origin of infectious agents, and route of dissemination. PATIENTS AND METHODS This was a retrospective cohort study with prospective data collection of patients operated on from 2013 to 2015. Early-onset IHMI was defined as symptoms developed within one year after the index surgery, whereas late-onset IHMI was defined as infection developed later than a year after the index surgery. Age, gender, ASA score, BMI, time from index surgery, isolated infectious agents and possible pathogeneses were analyzed. RESULTS During the study period, 1438 patients underwent inguinal hernia repair. Sixteen patients (1.1%) had IHMI, of whom nine were early-onset and seven late-onset. The groups were comparable for age (p = .54), gender (p = 1.0), BMI (p = .79), and ASA score (p = 1.0). The most common infectious agent in early-onset IHMI was St. aureus, whereas Enterococci and Enterobacter prevailed in late-onset IHMI. The possible pathogenesis of IHMI in seven patients with early-onset IHMI was primary exogenous infection, whereas in patients with late-onset IHMI the pathogenesis might be hematogenous or contact spread. All patients with IHMI underwent mesh removal. In two patients (one from each group), partial mesh removal was performed previously and IHMI recurred. CONCLUSIONS Early-onset hernia mesh infection is mostly caused by St. aureus through exogenous contamination, whereas its late-onset counterpart might be a result of hematogenous or contact spread of intestinal flora.
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Affiliation(s)
- Mahir Gachabayov
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Rifat Latifi
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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11
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Repply to «Antibiotic prophylaxis in inguinal hernia surgery». Enferm Infecc Microbiol Clin 2021. [PMID: 34030904 DOI: 10.1016/j.eimc.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Fernández-Roldán C, Turiño-Luque JD. Antibiotic prophylaxis in inguinal hernia surgery. ACTA ACUST UNITED AC 2021; 39:365-366. [PMID: 34353521 DOI: 10.1016/j.eimce.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Concepción Fernández-Roldán
- Microbiología y Parasitología Clínica, Especialista en Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Jesús Damián Turiño-Luque
- Microbiología y Parasitología Clínica, Especialista en Cirugía General y Aparato Digestivo, Unidad de Cirugía Mayor Ambulatoria y Corta Estancia, Hospital Regional Universitario de Málaga, Málaga, Spain.
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13
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Del Toro-López MD, Badía-Pérez JM. Reply to "Antibiotic prophylaxis in inguinal hernia surgery". ACTA ACUST UNITED AC 2021; 39:366-367. [PMID: 34353522 DOI: 10.1016/j.eimce.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022]
Affiliation(s)
- María Dolores Del Toro-López
- Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla, Sevilla, Spain.
| | - Josep María Badía-Pérez
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Catalunya, Spain
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14
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Fernández-Roldán C, Turiño-Luque JD. Antibiotic prophylaxis in inguinal hernia surgery. Enferm Infecc Microbiol Clin 2021. [PMID: 33865635 DOI: 10.1016/j.eimc.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Concepción Fernández-Roldán
- Microbiología y Parasitología Clínica. Especialista en Medicina Interna. Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Jesús Damián Turiño-Luque
- Microbiología y Parasitología Clínica. Especialista en Cirugía General y Aparato Digestivo. Unidad de Cirugía Mayor Ambulatoria y Corta Estancia. Hospital Regional Universitario de Málaga, Málaga, España.
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15
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Williams ML, Hutchinson AG, Oh DD, Young CJ. Trends in Australian inguinal hernia repair rates: a 15‐year population study. ANZ J Surg 2020; 90:2242-2247. [DOI: 10.1111/ans.16192] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael L. Williams
- Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Adam G. Hutchinson
- Department of General Surgery Bendigo Hospital Bendigo Victoria Australia
| | - Daniel D. Oh
- Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Christopher J. Young
- Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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16
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Orelio CC, van Hessen C, Sanchez-Manuel FJ, Aufenacker TJ, Scholten RJ. Antibiotic prophylaxis for prevention of postoperative wound infection in adults undergoing open elective inguinal or femoral hernia repair. Cochrane Database Syst Rev 2020; 4:CD003769. [PMID: 32315460 PMCID: PMC7173733 DOI: 10.1002/14651858.cd003769.pub5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inguinal or femoral hernia is a tissue protrusion in the groin region and has a cumulative incidence of 27% in adult men and of 3% in adult women. As most hernias become symptomatic over time, groin hernia repair is one of the most frequently performed surgical procedures worldwide. This type of surgery is considered 'clean' surgery with wound infection rates expected to be lower than 5%. For clean surgical procedures, antibiotic prophylaxis is not generally recommended. However after the introduction of mesh-based hernia repair and the publication of studies that have high wound infection rates the debate as to whether antibiotic prophylaxis is required to prevent postoperative wound infections started again. OBJECTIVES To determine the effectiveness of antibiotic prophylaxis in reducing postoperative (superficial and deep) wound infections in elective open inguinal and femoral hernia repair. SEARCH METHODS We searched several electronic databases: Cochrane Registry of Studies Online, MEDLINE Ovid, Embase Ovid, Scopus and Science Citation Index (search performed on 12 November 2019). We also searched two trial registers and the reference list of included studies. SELECTION CRITERIA We included randomised controlled trials comparing any type of antibiotic prophylaxis versus placebo or no treatment for preventing postoperative wound infections in adults undergoing inguinal or femoral open hernia repair surgery (tissue repair and mesh repair). DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed risk of bias. We separately analysed results for two different surgical methods (herniorrhaphy and hernioplasty). Several studies revealed infection rates that were higher than the expected 5% for clean surgery and we therefore divided studies into two subgroups: high infection risk environments (≥ 5% infection rate); and low infection risk environments (< 5% infection rate). We performed meta-analyses with random-effects models. We analysed three outcomes: superficial surgical site infections (SSSI); deep surgical site infections (DSSI); and all postoperative wound infections (SSSI + DSSI). MAIN RESULTS In this review update we identified and included 10 new studies. In total, we included 27 studies with 8308 participants in this review. It is uncertain whether antibiotic prophylaxis as compared to placebo (or no treatment) prevents all types of postoperative wound infections after herniorrhaphy surgery (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.56 to 1.33; 5 studies, 1865 participants; very low quality evidence). Subgroup analysis did not change these results. We could not perform meta-analyses for SSSI or DSSI as these outcomes were not reported separately. Twenty-two studies related to hernioplasty surgery (total of 6443 participants) and we analysed three outcomes: SSSI; DSSI; SSSI + DSSI. Within the low infection risk environment subgroup, antibiotic prophylaxis as compared to placebo probably makes little or no difference for the outcomes 'prevention of all wound infections' (RR 0.71, 95% CI 0.44 to 1.14; moderate-quality evidence) and 'prevention of SSSI' (RR 0.71, 95% CI 0.44 to 1.17, moderate-quality evidence). Within the high infection risk environment subgroup it is uncertain whether antibiotic prophylaxis reduces all types of wound infections (RR 0.58, 95% CI 0.43 to 0.77, very low quality evidence) or SSSI (RR 0.56, 95% CI 0.41 to 0.77, very low quality evidence). When combining participants from both subgroups, antibiotic prophylaxis as compared to placebo probably reduces the risk of all types of wound infections (RR 0.61, 95% CI 0.48 to 0.78) and SSSI (RR 0.60, 95% CI 0.46 to 0.78; moderate-quality evidence). Antibiotic prophylaxis as compared to placebo probably makes little or no difference in reducing the risk of postoperative DSSI (RR 0.65, 95% CI 0.26 to 1.65; moderate-quality evidence), both in a low infection risk environment (RR 0.67, 95% CI 0.11 to 4.13; moderate-quality evidence) and in the high infection risk environment (RR 0.64, 95% CI 0.22 to 1.89; low-quality evidence). AUTHORS' CONCLUSIONS Evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces the risk of postoperative wound infections after herniorrhaphy surgery. Evidence of moderate quality shows that antibiotic prophylaxis probably makes little or no difference in preventing wound infections (i.e. all wound infections, SSSI or DSSI) after hernioplasty surgery in a low infection risk environment. Evidence of low quality shows that antibiotic prophylaxis in a high-risk environment may reduce the risk of all wound infections and SSSI, while evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces DSSI after hernioplasty surgery.
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Affiliation(s)
- Claudia C Orelio
- Diakonessenhuis Utrecht, Research Support, Bosboomstraat 1, Utrecht, Netherlands, 3582 KE
| | - Coen van Hessen
- Diakonessenhuis Utrecht, Liesbreukcentrum Nederland, Bosboomstraat 1, Utrecht, Netherlands, 3582 KE
| | | | | | - Rob Jpm Scholten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Cochrane Netherlands, Room Str. 6.126, P.O. Box 85500, Utrecht, Netherlands, 3508 GA
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17
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Jin C, Shen Y, Chen J. Laparoscopic evaluation and management of 47 patients with late-onset mesh infection after inguinal hernioplasty. Hernia 2020; 24:381-385. [PMID: 32096089 DOI: 10.1007/s10029-020-02141-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/11/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Mesh infection after inguinal hernioplasty can be complicated especially when it is caused by chronic fistula. Explantation of the infected mesh is inevitable when conservative treatment fails and is considered to be the key step toward development of future therapies. Our purpose was to determine the results of laparoscopic exploration and summarize the treatment experience of the late-onset mesh infection. METHODS We analyzed 47 patients with late-onset mesh infection treated at our hernia center. The medical records of these patients were retrospectively reviewed, and information regarding presentation, approach of previous hernia repair, type of mesh, operative findings, bacteriological examination result, and postoperative complications were obtained. All of the patients underwent laparoscopic exploration to identify the abscess and fistula, further debridement and treatment was performed afterwards according to the exploration results. RESULTS All the operative courses were uneventful. Laparoscopy revealed four intestinal fistula and one bladder fistula. Four cases of all underwent debridement and drainage using laparoscopic approach only, and the others were converted to open surgery after laparoscopic exploration to remove the infected mesh. There were two hernia recurrence and nine wound infection during the follow-up period; all the patients had an eventually recovery. CONCLUSIONS Laparoscopic exploration is an effective and minimally invasive method for managing the late-onset infection which can identify whether internal organ was involved and consult for the further treatment. The approach of mesh removal should be tailored according to the exploration results.
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Affiliation(s)
- C Jin
- Department of Hernia and Abdominal Wall Surgery, The Capital Medical University Beijing Chaoyang Hospital, Jingyuan Road No. 5, Shijingshan District, Beijing, 100043, China
| | - Y Shen
- Department of Hernia and Abdominal Wall Surgery, The Capital Medical University Beijing Chaoyang Hospital, Jingyuan Road No. 5, Shijingshan District, Beijing, 100043, China.
| | - J Chen
- Department of Hernia and Abdominal Wall Surgery, The Capital Medical University Beijing Chaoyang Hospital, Jingyuan Road No. 5, Shijingshan District, Beijing, 100043, China
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18
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Polydopamine-Inspired Surface Modification of Polypropylene Hernia Mesh Devices via Cold Oxygen Plasma: Antibacterial and Drug Release Properties. COATINGS 2019. [DOI: 10.3390/coatings9030164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Mesh infection is a major complication of hernia surgery after polypropylene (PP) mesh implantation. Modifying the PP mesh with antibacterial drugs is an effective way to reduce the chance of infection, but the hydrophobic characteristic of PP fibers has obstructed the drug adhesion. Therefore, to prepare antimicrobial PP mesh with a stable drug coating layer and to slow the drug release property during the hernia repair process has a great practical meaning. In this work, PP meshes were coated by bio-inspired polydopamine (PDA), which can load and release levofloxacin. PP meshes were activated with cold oxygen plasma and then plasma activated PP fibers were coated with PDA. The PDA coated meshes were further soaked in levofloxacin. The levofloxacin loaded PP meshes demonstrate excellent antimicrobial properties for 6 days and the drug release has lasted for at least 24 h. Moreover, a control PP mesh sample without plasma treatment was also prepared, after coating with PDA and loading levofloxacin. The antimicrobial property was sustained only for two days. The maximum inhibition zone of PDA coated meshes with and without plasma treatment was 12.5 and 9 mm, respectively. On all accounts, the modification strategy can facilely lead to long-term property of infection prevention.
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19
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Claus CMP, Oliveira FMMD, Furtado ML, Azevedo MA, Roll S, Soares G, Nacul MP, Rosa ALMD, Melo RMD, Beitler JC, Cavalieri MB, Morrell AC, Cavazzola LT. Orientações da Sociedade Brasileira de Hérnia (SBH) para o manejo das hérnias inguinocrurais em adultos. Rev Col Bras Cir 2019; 46:e20192226. [DOI: 10.1590/0100-6991e-20192226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/18/2019] [Indexed: 01/06/2023] Open
Abstract
RESUMO As hérnias inguinais são um problema frequente e o seu reparo representa a cirurgia mais comumente realizada por cirurgiões gerais. Nos últimos anos, novos princípios, produtos e técnicas têm mudado a rotina dos cirurgiões que precisam reciclar conhecimentos e aperfeiçoar novas habilidades. Além disso, antigos conceitos sobre indicação cirúrgica e riscos de complicações vêm sendo reavaliados. Visando criar um guia de orientações sobre o manejo das hérnias inguinais em pacientes adultos, a Sociedade Brasileira de Hérnias reuniu um grupo de experts com objetivo de revisar diversos tópicos, como indicação cirúrgica, manejo perioperatório, técnicas cirúrgicas, complicações e orientações pós-operatórias.
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20
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Tubre DJ, Schroeder AD, Estes J, Eisenga J, Fitzgibbons RJ. Surgical site infection: the "Achilles Heel" of all types of abdominal wall hernia reconstruction. Hernia 2018; 22:1003-1013. [PMID: 30276561 DOI: 10.1007/s10029-018-1826-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/14/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Surgical site infection is the most common hospital-acquired infection in surgical patients. Recently, public health organizations have updated prevention guidelines. This review discusses surgical site infections as a complication of abdominal wall reconstruction. METHODS The authors reviewed guidelines on prevention of surgical site infections from the Center for Disease Control and Prevention, World Health Organization, and National Institute for Health and Care Excellence and put them into context with the relevant abdominal wall reconstruction literature. This was the subject of the Nyhus-Wantz lecture given at The International Hernia Congress on March 14, 2018 in Miami, FL and is summarized here. RESULTS Routine use of preoperative antibiotics in prosthetic groin hernia repair is not supported by the available literature. High-quality data on antibiotic prophylaxis in ventral (both primary and incisional) hernia repair is lacking, but it is widely utilized and may reduce SSIs. Recommended preventative strategies discussed in this manuscript include: treatment of remote site infections, perioperative normothermia and normoglycemia, avoidance of hypoxemia, antiseptic preparation of surgical team hands and patient skin, treatment of obesity, smoking cessation, correction of malnutrition, and physical conditioning. CONCLUSION Surgical site infections lead to significant morbidity and mortality, hernia recurrences, prolonged hospital stay, and increased hospital costs. This makes surgical site infections the "Achilles Heel" of abdominal wall reconstruction. Strict adherence to standardized guidelines and preoperative optimization of patients' risk profiles are crucial to decrease the incidence of surgical site infections.
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Affiliation(s)
- D J Tubre
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA
| | - A D Schroeder
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA
| | - J Estes
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - J Eisenga
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - R J Fitzgibbons
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA.
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21
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Surgical antibiotic prophylaxis – The evidence and understanding its impact on consensus guidelines. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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Kulaçoğlu H. Comments on the new groin hernia guidelines: What has changed? What has remained unanswered? Turk J Surg 2018; 34:83-88. [PMID: 30023968 DOI: 10.5152/turkjsurg.2018.4146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/09/2018] [Indexed: 01/15/2023]
Abstract
Guidelines are meant to evaluate the options available in the current circumstances and suggest the proper solutions for particular problems. The duty of a guideline is to present a basis for decision-making. Surgical options for the treatment of groin hernias are numerous. Recently, a joint guideline called "International Guidelines for Groin Hernia Management" was developed by five continental hernia societies, the International Endo hernia Society, and the European Association for Endoscopic Surgery. This article aimed to review the methodology, statements, and recommendations of the new guidelines and emphasized the importance of the tailored surgery for groin hernias. Spreading the guidelines may provide surgeons with an up-to-date knowledge and be useful for better outcomes in groin hernia surgery.
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23
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Stabilini C, Cavallaro G, Bocchi P, Campanelli G, Carlucci M, Ceci F, Crovella F, Cuccurullo D, Fei L, Gianetta E, Gossetti F, Greco DP, Iorio O, Ipponi P, Marioni A, Merola G, Negro P, Palombo D, Bracale U. Defining the characteristics of certified hernia centers in Italy: The Italian society of hernia and abdominal wall surgery workgroup consensus on systematic reviews of the best available evidences. Int J Surg 2018; 54:222-235. [PMID: 29730074 DOI: 10.1016/j.ijsu.2018.04.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/06/2018] [Accepted: 04/28/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The terms "Hernia Center" (HC) and Hernia Surgeon" (HS) have gained more and more popularity in recent years. Nevertheless, there is lack of protocols and methods for certification of their activities and results. The Italian Society of Hernia and Abdominal Wall Surgery proposes a method for different levels of certification. METHODS The national board created a commission, with the task to define principles and structure of an accreditation program. The discussion of each topic was preceded by a Systematic Review, according to PRISMA Guidelines and Methodology. In case of lack or inadequate data from literature, the parameter was fixed trough a Commission discussion. RESULTS The Commission defined a certification process including: "FLC - First level Certification": restricted to single surgeon, it is given under request and proof of a formal completion of the learning curve process for the basic procedures and an adequate year volume of operations. "Second level certification": Referral Center for Abdominal Wall Surgery. It is a public or private structure run by at least two already certified and confirmed FLC surgeons. "Third level certification": High Specialization Center for Abdominal Wall Surgery. It is a public or private structure, already confirmed as Referral Centers, run by at least three surgeons (two certified and confirmed with FLC and one research fellow in abdominal wall surgery). Both levels of certification have to meet the Surgical Requirements and facilities criteria fixed by the Commission. CONCLUSION The creation of different types of Hernia Centers is directed to create two different entities offering the same surgical quality with separate mission: the Referral Center being more dedicated to clinical and surgical activity and High Specialization Centers being more directed to scientific tasks.
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Affiliation(s)
| | | | | | | | - Michele Carlucci
- Department of General and Emergency Surgery, IRCCS San Raffaele, Milan, Italy
| | - Francesca Ceci
- Department of Surgery "P. Stefanini", Sapienza University, Rome, Italy
| | | | - Diego Cuccurullo
- Department of General, Laparoscopic, and Robotic Surgery, Ospedale Monaldi, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Landino Fei
- Department of Anaesthesiological, Surgical and Emergency Sciences, Second University of Naples, Italy
| | - Ezio Gianetta
- Department of Surgical Sciences, University of Genoa, Italy
| | | | | | - Olga Iorio
- General Surgery Unit, Aprilia Hospital, Aprilia (RM), Italy
| | - Pierluigi Ipponi
- General Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | | | - Giovanni Merola
- Department of Surgical Spaciailties and Nephrology, Federico II University, Naples, Italy
| | - Paolo Negro
- Department of Surgery "P. Stefanini", Sapienza University, Rome, Italy
| | - Denise Palombo
- Department of Surgical Sciences, University of Genoa, Italy
| | - Umberto Bracale
- Department of Surgical Spaciailties and Nephrology, Federico II University, Naples, Italy
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Guillaume O, Pérez-Tanoira R, Fortelny R, Redl H, Moriarty TF, Richards RG, Eglin D, Petter Puchner A. Infections associated with mesh repairs of abdominal wall hernias: Are antimicrobial biomaterials the longed-for solution? Biomaterials 2018; 167:15-31. [PMID: 29554478 DOI: 10.1016/j.biomaterials.2018.03.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/30/2022]
Abstract
The incidence of mesh-related infection after abdominal wall hernia repair is low, generally between 1 and 4%; however, worldwide, this corresponds to tens of thousands of difficult cases to treat annually. Adopting best practices in prevention is one of the keys to reduce the incidence of mesh-related infection. Once the infection is established, however, only a limited number of options are available that provides an efficient and successful treatment outcome. Over the past few years, there has been a tremendous amount of research dedicated to the functionalization of prosthetic meshes with antimicrobial properties, with some receiving regulatory approval and are currently available for clinical use. In this context, it is important to review the clinical importance of mesh infection, its risk factors, prophylaxis and pathogenicity. In addition, we give an overview of the main functionalization approaches that have been applied on meshes to confer anti-bacterial protection, the respective benefits and limitations, and finally some relevant future directions.
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Affiliation(s)
- O Guillaume
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland.
| | - R Pérez-Tanoira
- Division of Infectious Diseases, IIS-Fundación Jiménez Díaz, Madrid, Spain; Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - R Fortelny
- Department of General, Visceral and Oncologic Surgery, Wilhelminen Hospital, Montleartstrasse 37, 1160, Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria; Sigmund Freud University, Medical Faculty, Kelsenstraße 2, A-1030, Vienna, Austria
| | - H Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Donaueschingenstrasse 13, A-1200, Vienna, Austria
| | - T F Moriarty
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - R G Richards
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - D Eglin
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - A Petter Puchner
- Department of General, Visceral and Oncologic Surgery, Wilhelminen Hospital, Montleartstrasse 37, 1160, Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria
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25
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Sanbhal N, Mao Y, Sun G, Li Y, Peerzada M, Wang L. Preparation and Characterization of Antibacterial Polypropylene Meshes with Covalently Incorporated β-Cyclodextrins and Captured Antimicrobial Agent for Hernia Repair. Polymers (Basel) 2018; 10:E58. [PMID: 30966099 PMCID: PMC6415163 DOI: 10.3390/polym10010058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/20/2017] [Accepted: 01/05/2018] [Indexed: 11/30/2022] Open
Abstract
Polypropylene (PP) light weight meshes are commonly used as hernioplasty implants. Nevertheless, the growth of bacteria within textile knitted mesh intersections can occur after surgical mesh implantation, causing infections. Thus, bacterial reproduction has to be stopped in the very early stage of mesh implantation. Herein, novel antimicrobial PP meshes grafted with β-CD and complexes with triclosan were prepared for mesh infection prevention. Initially, PP mesh surfaces were functionalized with suitable cold oxygen plasma. Then, hexamethylene diisocyanate (HDI) was successfully grafted on the plasma-activated PP surfaces. Afterwards, β-CD was connected with the already HDI reacted PP meshes and triclosan, serving as a model antimicrobial agent, was loaded into the cyclodextrin (CD) cavity for desired antibacterial functions. The hydrophobic interior and hydrophilic exterior of β-CD are well suited to form complexes with hydrophobic host guest molecules. Thus, the prepared PP mesh samples, CD-TCL-2 and CD-TCL-6 demonstrated excellent antibacterial properties against Staphylococcus aureus and Escherichia coli that were sustained up to 11 and 13 days, respectively. The surfaces of chemically modified PP meshes showed dramatically reduced water contact angles. Moreover, X-ray diffractometer (XRD), differential scanning calorimeter (DSC), and Thermogravimetric (TGA) evidenced that there was no significant effect of grafted hexamethylene diisocyanate (HDI) and CD on the structural and thermal properties of the PP meshes.
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Affiliation(s)
- Noor Sanbhal
- Key Laboratory of Textile Science and Technology of Ministry of Education, Room 4023, College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang, Shanghai 201620, China.
- Department of Textile Engineering, Mehran University of Engineering and Technology, Jamshoro 76062, Sindh, Pakistan.
| | - Ying Mao
- Key Laboratory of Textile Science and Technology of Ministry of Education, Room 4023, College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang, Shanghai 201620, China.
| | - Gang Sun
- Key Laboratory of Textile Science and Technology of Ministry of Education, Room 4023, College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang, Shanghai 201620, China.
- Division of Textiles and Clothing, University of California, Davis, CA 95616, USA.
| | - Yan Li
- Key Laboratory of Textile Science and Technology of Ministry of Education, Room 4023, College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang, Shanghai 201620, China.
| | - Mazhar Peerzada
- Department of Textile Engineering, Mehran University of Engineering and Technology, Jamshoro 76062, Sindh, Pakistan.
| | - Lu Wang
- Key Laboratory of Textile Science and Technology of Ministry of Education, Room 4023, College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang, Shanghai 201620, China.
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Kockerling F. Antibiotic prophylaxis in laparoendoscopic hernia surgery. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2018. [DOI: 10.4103/ijawhs.ijawhs_4_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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