Commentary: Hernia, Mesh, and Topical Antibiotics, Especially Gentamycin: Seeking the Evidence for the Perfect Outcome…

It was a pleasure to go through the manuscript by Hacan Kulacoglou (1) published in Frontiers in Surgery, which focuses on topical antibiotic prophylaxis use especially gentamycin in clean surgeries such as in inguinal hernia mesh reconstructions, as he brings up excellent discussion topics. Indisputably there are benefits in using antibiotics topically rather than orally or intravenously, reducing the chances of bacterial resistance and presumably the risk of having a surgical site infection (SSI), however leading to unwanted effects development, with the most common being contact dermatitis (2). It has been suggested that gentamycin, topically or parenterally administered (1), is effective especially against Gram-negative bacteria; however, its use as empirical monotherapy or in combination with other antibiotics in clean surgeries has not been officially comparatively evaluated. Antibiotic choice, duration, dose, dosing interval, and first dose timing in contaminated but also in clean fields appear significant and would rather depend on the antibiotic’s adverse effect profile, drug interactions, and the probability of bacterial resistance, especially given the emergence of bacterial resistance to third-generation cephalosporins, causing great concerns. Although antibiotic prophylaxis is not mandatory in clean, elective operations, regular use of implants, accounting a 90% of inguinal hernia repairs, creates controversies (2). The European Hernia Society (3) does not suggest routine antibiotic prophylaxis. However, it is recommended where patient-related or procedure-related risks exist, as also Mazaki et al. indicated in a randomized controlled trial, showing that prophylaxis use proves to have effect on SSI prevention (4). Interestingly, mesh use in inguinal hernia reconstructive surgeries does not necessarily lead to greater wound infection risk (5). Latest data concerning wound infections regarding open mesh contrarily to non-mesh techniques used in inguinal hernia reconstructive surgeries suggest that deep infections surface rare and do not necessarily lead to mesh removal when monoor multifilament mesh fabrics are applied along with drainage. Furthermore, the majority of RCTs are against using prophylaxis