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Prevention of Surgical Site Infection After Open Prosthetic Inguinal Hernia Repair: Efficacy of Parenteral Versus Oral Prophylaxis with Amoxicillin-Clavulanic Acid in a Randomized Clinical Trial

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Abstract

The aim of this prospective study was to compare the efficacy of oral versus parenteral prophylactic amoxicillin–clavulanic acid for preventing surgical site infection after open prosthetic mesh repair of inguinal hernia. A total of 480 inguinal-hernia patients were randomly assigned to two groups. Group I (n = 240) received 1.313 g oral amoxicillin–clavulanic acid 2 hours before operation, and group II (n = 240) received 1.2 g of the same drug combination intravenously approximately 30 minutes before surgery. Patients were examined four times during 1 year of follow-up (at 7–10 days, 4–6 weeks, 6 months, and 12 months postoperation), and data related to surgical site infections were collected. Seventy-two patients were excluded due to confounding factors during and after the operation. There were no statistically significant differences between group I (final n = 208) and group II (final n = 200) with respect to age, sex distribution, body mass index, American Anesthesiology Association grade, frequencies of different hernia types, duration of surgery, and the experience levels of the principal surgeon in the operations. One of the 208 (0.5%) patients in group I and 3 of the 200 (1.5%) patients in group II developed superficial surgical site infections (p > 0.05). None of the infections required mesh removal. There were no deep surgical site infections in either group, and there was one case of hernia recurrence in each group. For patients undergoing open prosthetic repair of inguinal hernia, oral amoxicillin–clavulanic acid is safe, significantly less costly, and equally effective in preventing surgical site infection as the same dose given parenterally.

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Acknowledgment

The authors thank Associate Professor Dr. Hakan Ergün (Department of Pharmacology, University of Ankara) for his generous help with this study.

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Authors and Affiliations

  1. Department of Surgery, Ankara University School of Medicine, 06100 Sýhhýye, Ankara, Turkery

    Mehmet A. Kuzu M.D., Selçuk Hazinedaroğlu M.D., Şükrü Dolalan M.D., Namık Özkan M.D., Samet Yalçın M.D., A. Bülent Erkek M.D., Hatem Mahmoudi M.D., Acar Tüzüner M.D. & Ercümet Kuterdem M.D.

  2. Department of Biostatistics, Ankara University School of Medicine, 06100 Sýhhýye, Ankara, Turkery

    Atilla H. Elhan Ph.D.

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  1. Mehmet A. Kuzu M.D.
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Correspondence to Mehmet A. Kuzu M.D..

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Conflict of Interest Statement: This study was not sponsored by a commercial enterprise, and none of the authors had any financial interest in the outcome.

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Kuzu, M.A., Hazinedaroğlu, S., Dolalan, Ş. et al. Prevention of Surgical Site Infection After Open Prosthetic Inguinal Hernia Repair: Efficacy of Parenteral Versus Oral Prophylaxis with Amoxicillin-Clavulanic Acid in a Randomized Clinical Trial. World J. Surg. 29, 794–799 (2005). https://doi.org/10.1007/s00268-005-7689-0

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