Effectiveness of Prophylactic Antibiotics in Inguinal Hernia Repair Surgery: Experience from a Surgical Unit at National Hospital Galle - an audit

Inguinal hernia mesh repair is a common surgical procedure where the use of Antibiotic Prophylaxis (AP) remains controversial. This audit evaluated AP practices and Surgical Site Infection (SSI) rates at a tertiary care center in Sri Lanka, benchmarking against international and local guidelines.
A retrospective study was conducted at the University Surgical Unit, National Hospital Galle, involving 90 adult patients who underwent elective open (Lichtenstein) or laparoscopic Transabdominal Preperitoneal (TAPP) mesh repair between November 2023 and November 2025. Data on demographics, comorbidities, antibiotic regimens, and postoperative outcomes were analyzed.
The majority of patients were male (96.7%) with a mean age of 57.3 years. Open repair surgery was performed in 70% of cases. Despite guidelines recommending single-dose or no prophylaxis, 83.3% (n=75) of patients received multi-dose antibiotic regimens. Only 10% received a single dose, and 6.7% received no antibiotics. The overall SSI rate was 3.3% (n=3), all of which were superficial incisional infections. Notably, all SSIs occurred in the multi-dose group, while no infections were recorded in the single-dose or no-antibiotic groups. Statistical analysis showed no significant association between the AP regimen and SSI incidence.
This audit indicates that multi-dose antibiotic regimens offer no additional benefit over single-dose or no prophylaxis in preventing SSIs following inguinal hernia repair. Adherence to current evidence-based, single-dose protocols is recommended to maintain surgical safety, reduce healthcare costs, and improve antimicrobial stewardship.