From the Guidelines
Patients with incarcerated hernias should receive antibiotics only if there are signs of strangulation, infection, or bowel compromise, with the specific regimen and duration guided by the severity of the condition and the presence of bowel resection. When treating incarcerated hernias, the primary concern is to prevent morbidity, mortality, and reduce the impact on quality of life. According to the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1, the use of antibiotics is recommended in specific scenarios.
- For patients with intestinal incarceration and no evidence of ischemia, and no bowel resection (CDC wound class I), short-term prophylaxis is recommended 1.
- In cases of intestinal strangulation and/or concurrent bowel resection (CDC wound classes II and III), 48-h antimicrobial prophylaxis is advised 1.
- For patients with peritonitis (CDC wound class IV), antimicrobial therapy is recommended 1. The choice of antibiotic regimen should be based on the severity of the condition and the potential for bacterial contamination, with common regimens including cefazolin, clindamycin, gentamicin, piperacillin-tazobactam, or ertapenem. It's crucial to note that the primary treatment for incarcerated hernias remains prompt surgical intervention to release the trapped tissue and repair the hernia defect, with antibiotic use serving as an adjunct to prevent infection in high-risk cases.
From the Research
Incarcerated Hernia Treatment
- The use of antibiotics in the treatment of incarcerated hernias is a topic of debate, with some studies suggesting that antibiotic prophylaxis may be beneficial in reducing postoperative wound infection rates 2.
- A systematic review of 17 randomized clinical trials found that the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended, but may be considered in cases with high rates of wound infection 2.
- In the context of incarcerated hernias, a study found that mesh repair was feasible and safe, with a lower recurrence rate compared to anatomic repair, but the use of mesh in cases with concomitant bowel resection requires further study 3.
- Another study found that emergency laparoscopic treatment of acute incarcerated incisional hernia was a viable option, with low rates of complications and no recurrence or mortality 4.
- The role of antibiotics in the treatment of incarcerated hernias is not explicitly addressed in all studies, but it is suggested that antibiotic prophylaxis may be considered in certain cases, such as those with high rates of wound infection or in cases where mesh repair is used 2, 3.
Antibiotic Use
- The use of antibiotics in hernia repair is a controversial issue, with some studies suggesting that antibiotic prophylaxis may be beneficial in reducing postoperative wound infection rates 2.
- A study found that the incidence of surgical site infection (SSI) was not significantly different between patients with incarcerated hernia who underwent mesh repair and those who underwent anatomic repair, but the use of mesh repair was associated with a lower recurrence rate 3.
- In cases where mesh repair is used, the risk of mesh infection is a concern, but most cases of infections can be well controlled with conservative antibiotic therapy 3.
Treatment Options
- The treatment of incarcerated hernias can involve various approaches, including open repair, laparoscopic repair, and mesh repair 5, 3, 4.
- A study found that taxis (hernia reduction) was a feasible and safe maneuver pending an eventual surgical treatment, with a success rate of 60.3% and no taxis-related complications 5.
- Emergency laparoscopic treatment of acute incarcerated incisional hernia is a viable option, with low rates of complications and no recurrence or mortality 4.