Efficacy of Antibiotic Impregnated Mesh in Hernia Surgery, a Meta-Analysis.

Abstract

Background: Hernia repair represents one of the most frequently undertaken surgical interventions globally. Despite advancements in surgical techniques and perioperative management, surgical site infections (SSIs) continue to constitute a major postoperative complication, contributing to increased patient morbidity, prolonged hospitalization, and elevated healthcare expenditures. The introduction of prosthetic mesh has markedly improved outcomes by reducing recurrence rates; nevertheless, the implantation of foreign material may inadvertently elevate the risk of infection through bacterial adherence, colonization, and subsequent biofilm formation. To mitigate these risks, antibiotic-impregnated meshes and prophylactic antibiotic regimens have been proposed as adjunctive strategies. However, the clinical efficacy of these interventions remains a subject of ongoing debate, with existing literature presenting heterogeneous and, at times, conflicting evidence.

Objective: To systematically evaluate the efficacy of antibiotic-impregnated mesh in reducing surgical site infections following hernia repair through a comprehensive meta-analysis of randomized controlled trials and comparative studies.

Methods: A systematic literature search was conducted across multiple electronic databases including PubMed, Scopus, and Web of Science to identify relevant studies published up to June 2025. The search strategy employed Medical Subject Headings (MeSH) terms and keywords related to antibiotic-impregnated mesh, hernia repair, infection, and prophylaxis. Two independent reviewers screened titles, abstracts, and full-text articles according to predefined inclusion and exclusion criteria. Data extraction was performed using a standardized form, capturing study characteristics, patient demographics, intervention details, and infection outcomes. Statistical analysis included calculation of odds ratios with 95% confidence intervals, generation of forest plots for effect visualization, and funnel plots for publication bias assessment. The meta-analysis was conducted in accordance with PRISMA guidelines.

Results: Eleven primary randomized controlled trials and comparative studies were included, encompassing 2,898 patients undergoing various types of hernia repair (inguinal, incisional, ventral, femoral, and umbilical). The studies were published between 2004 and 2025, with sample sizes ranging from 52 to 1,040 participants. Various antibiotic types were employed, including Gentamicin, Rifampicin, Tetracycline, Clindamycin, Monocycline, Bacitracin and Cefazoline via topical routes. Infection rates varied considerably across studies, ranging from 0% to 15.4% in intervention groups and 0% to 20% in control groups. The analysis revealed substantial heterogeneity in study methodologies, antibiotic protocols, mesh types, follow-up durations, and infection definitions. Some studies demonstrated significant reductions in SSI rates with antibiotic interventions, while others showed no statistically significant differences. Publication bias assessment through funnel plots suggested potential asymmetry, indicating possible selective reporting of positive results.

Conclusion: Although some evidence indicates potential benefits of antibiotic-impregnated meshes in reducing surgical site infections following hernia repair, the substantial heterogeneity and methodological limitations within the existing literature preclude definitive conclusions and routine clinical endorsement. Variations in antibiotic agents, dosing strategies, timing of administration, mesh composition, and patient populations further complicate the interpretation of outcomes.