ИМХО, проблема несколько более запутана - сушеcтвуют различные мнения (как всегда)!
Например: It is very important to underline that in incisional hernia the success of the procedure can be guaranteed only by an accurate preparation of the preperitoneal space: perfect haemostasis, temporary closure of the space inserting iodine gauzes, local antibiotic treatment, washing of the cavity and accurate drainage [3].
In general preperitoneal repair permits to have a wide vision of the inguinal, crural, and spigelian region. The dissection of this space allows to position a wide mesh that repairs the entire region with less risk of recurrence. The peritoneum also isolates the peritoneal cavity from the mesh with less risk of contamination.
A systemic antibiotic therapy should be used as routine in these cases with higher risk of infection. Many studies have proven the validity of antibiotic chemotherapy in the prevention of postoperative infections after prosthetic repair of the abdominal wall [10]. It is certain that both in non-complicated inguinal hernia and in abdominal wall hernia repairs the use of antibiotics can reduce significantly the number of infections. So particularly in operations in which we think that it is possible that enteric bacteria have contaminated the operating field we should use wide spectrum antibiotics that protect against gram + and gram – bacteria. There is no convincing evidence to suggest that the new-generation Cephalosporins are more effective than first-generation [10]. Some Authors suggest in standard prosthetic repair single dose of ampicillin and sulbactam, others Authors first – second generation cephalosporine/amoxicillin and clavulanic acid and others single dose cephtriaxone.
World Journal of Emergency Surgery 2008, 3:33
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Hernia repair has been traditionally considered as one of the so-called clean operations along with thyroid and breast surgery. Results from recent prospective studies, however, suggest that the wound infection rate in elective hernia repair is underestimated and, when the patients are appropriately followed up, the figure approaches or even exceeds 10%.[2,7,8] This figure is certainly not acceptable for a clean operation and some authors have suggested that we may need to re-classify hernia repair as a clean-contaminated procedure. On the other hand, during the last decade, the use of tension-free mesh repair techniques has become increasingly popular worldwide and it is considered today as the method of choice for elective inguinal hernia repair. The fear of infection of an introduced foreign body such as a non-absorbable mesh, raised the question of the potentially protective role of antibiotic prophylaxis, as this has been the case with other clean operations, such as arthoplasties and vascular graft implants.[9,10] In the light of the aforementioned data, many surgeons use antibiotics in elective hernia repair with mesh, although this practice is empiric rather than evidence based.............................In conclusion, we were not able to demonstrate any significant benefit from the addition of antibiotic prophylaxis (consisting of a single dose of ampicillin and clavoulanic) in elective inguinal hernia tension-free repair using a polypropylene mesh, in patients who were not at high risk of developing septic complications.
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