Antibiotic prophylaxis in umbilical and incisional hernia repair: a prospective randomised study.

OBJECTIVE: To find out if preoperative prophylaxis would reduce infection rates after umbilical and incisional hernia repair. DESIGN: Randomised controlled trial. SETTING: Teaching hospital, Israel. SUBJECTS: 35 Patients who presented with umbilical (n = 19) or incisional (n = 16) hernias during a period of 8 months. INTERVENTIONS: Cefonicid 1 g was given by intravenous infusion to alternate patients 30 minutes before the operation. MAIN OUTCOME MEASURES: Wound infection. RESULTS: The groups were comparable for age, body mass index, grade of surgeon, operating time, and size of hernial ring. The wound infection rates were 0/8 compared with 4/8 for incisional hernia repairs (p = 0.08) and 1/9 compared with 4/10 for umbilical hernia repairs (p = 0.3). The overall rate was 1/17 compared with 8/18 (p = 0.02). CONCLUSIONS: Single dose antibiotic puphylaxis seems to exert a beneficial effect on the wound infection rate after umbilical and incisional hernia repair.

[Repair of esophageal perforation with a diaphragmatic flap].

Perforation of the esophagus is life-threatening and requires prompt diagnosis. Immediate surgery with primary suture of the perforation is the treatment of choice. Any delay in diagnosis or treatment results in a sharp increase in mortality due to the combination of rapid development of necrotizing mediastinitis and inability to close the perforation surgically. To avoid leaks from the anastomosis the suture line can be buttressed with adjacent structures. The fundus of the stomach, parietal pleura and muscular flaps have been used to cover the perforation. We describe 2 patients with perforation of the lower esophagus. Both were operated on within 8 hours, the perforation was closed primarily and a diaphragmatic flap was formed to cover the suture line. There were no postoperative leaks and recovery was uneventful.