Mesh prosthesis, local anesthesia, and ambulatory care have been widely introduced in recent decades in the treatment of inguinal hernia. The use of antibiotic prophylaxis during open inguinal hernia repair has been controversial. No prospective trial has been conducted to assess the role of antibiotic prophylaxis in patients operated on for inguinal hernia under the above-mentioned conditions. A prospective, randomized, double-blinded trial was initiated to assess the efficacy of antibiotic prophylaxis in the prevention of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis. Ninety-nine consecutive hernia repairs were randomized to receive 1 g of parenteral Cefazolin preoperatively or a placebo. No wound infections existed in the therapeutic group (0/50). Four infections appeared in the control group (4/49), and the study was suspended for ethical reasons when differences reached values close to statistical significance ( P=0.059). We conclude that a single dose of intravenous Cefazolin decreases the risk of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis.

Summary:The anterior open tension-free hernioplasty popularized by the Lichtenstein group has gained world-wide acceptance and popularity. As described by the same group, utilization of a small sheet of mesh and failure to overlap the mesh with the pubic tubercle can lead to recurrence of the hernia. However, recurrence through the internal ring has not been reported. We report three recurrences from the internal ring area after open tension-free hernioplasty. The cause is discussed and the importance of making a mesh shutter mechanism at the internal ring in order to prevent indirect recurrence, is emphasized.Key words: Reccurrences -Anterior -Open -Tension-free -HernioplastyCorrespondence to: A. Celdr~n Received ]uly, 12, 1999 Accepted in final form April, 17, 2000 Analysis of recurrences following different methods of hernia repair is an important aspect of any series. Through better understanding of the mechanism of recurrence, the surgeon is able to refine the technique and thus prevent the recurrence. However, surgeons rarely have the opportunity to repair their own recurrences, and indeed, in most series, the reason for recurrence following the use of a specific operation :is not described. The anterior open tension-free mesh repair of inguinal hernia, described by the Lichtenstein group [Amid 1998], has simplified the application of tensionfree principles compared with other techniques which place the prosthesis in the properitoneal space [Stoppa 1984]. The former allows routine performance under local anesthesia in an ambulatory facility and achieves the same or a lower recurrence rate but with a shorter period of disability. In a critical scrutiny of their own procedure, Amid et al reported that inadequate mesh size and failure to overlap the mesh with the pubic tubercle can lead to recurrences below or above the mesh or at the pubic tubercle [Amid 1993]. This observation led to the group's recommendation to overlap the mesh with the pubic tubercle and utilize a wider mesh in order to provide sufficient contact between the mesh and tissue beyond the inguinal floor, as well as to provide adequate laxity for the mesh to compensate for the increased intra-abdominal pressure. The importance of using a wider mesh and allowing a certain degree of laxity became more obvious when they proved that after implantations the mesh decreases its size up to 2o% due to shrinkage [Amid 1997]. The purpose of this article is to report another cause of recurrence : when construction of the internal ring is not made in such a way as to create a shutter mechanism as described in the original Lichtenstein technique [Amid 1998 ] . Patients and resultsFrom October 1991 to December 1997 32o inguinal hernias were operated on, in 296 patients by one of the authors (AC) or residents assisted by him. Mean follow up was 44.6 m o n t h s (range 23 to 98). A 54-year-old man presented asymptomatic recurrence t h r o u g h the deep ring close to the spermatic cord 44 months postoperatively. Symptomatic recurrences were found in t...