Since Lichtenstein has popularized his technic for inguinal hernia repair in 1984, It quickly becomes 4 years later the gold standard to evaluate the other technical hernia repair[6][7][8] A large range of mesh have been created[9] One of the principal reason of this advancement is that studies show a lower rate of recurrence with mesh with no difference in adverse effect[8][10]. When compared to Shouldice technic, the best non mesh actual open technic, the recurrence rate is still lower for Lichtenstein hernioplasty, with a similar rate of pain occurrence[8].
Infection after hernioplasty is a rare complication, but when it occurs it can be very dangerous. The reported incidence of mesh-related infection following hernia repair varies from 1 to 8%, and the need to remove the mesh for the management of mesh infection was reported to be 0,13%. In a very large report conduct by H. Johanet, N. Contival about the management of mesh infection after inguinal hernia repair, a rate of infection of 0,07 was reported. They also report that for the 38 patients who were managed for mesh infection, 15 patients required primary removal of the mesh. The remaining 23 underwent conservative treatment. (18 patients) 78,2% of those failed to the conservative management and required the removal of the mesh[10].
While Intravenous antibiotics and mesh excision are the keystones in the management of mesh infections, there are some specificities according to the type of mesh that has been used. In case of infection with polyester or polypropylene, some studies recommend drainage and the use of antimicrobial agents. But if the infection involves an extended polytetrafluoroethylene mesh, the removal of the mesh could be the definitive treatment[10].
The use of antibiotics for the reduction of mesh infection after hernioplasty is very controversial[3]. E. Just et al. reported a 0,2% case of SSI for patients who receive antibiotic prophylaxis after hernioplasty, in comparison to 1,2% of cases of SSI for patients who did not receive any antibiotic prophylaxis.[8] More interestingly Yerdel et al showed in a similar study a tenfold difference of infection rate ( 0,7% in antibiotic arm vs 9% in the placebo arm)[5]. According to Aufenacker et al, there was no difference between the antibiotic prophylaxis group or the placebo group of patients who benefit from primary inguinal hernioplasty. In their study, they conclude that in Lichtenstein inguinal hernia repair, antibiotics prophylaxis is not indicated in low-risk patients[6]. Mazaki et al in a meta-analysis suggest that prophylactic antibiotic is efficacious for the prevention of SSI after open mesh hernia repair[2].
The use of intravenous antibiotic prophylaxis can be risky for the patients, anaphylaxis, hypersensitivity, interstitial nephritis is part of those risk. This justifies the idea of looking for an alternate way to conduct antibiotic prophylaxis, as the local route used in our study.
As the result is very limited with his low power. We can continue the investigation to more patients to see if we can find more data’s supporting the use of local mesh-soaked antibiotics for the prevention of infection after Lichtenstein hernioplasty.