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Pdf/CG74NICEG RP, Et Al Sudan Medical Journal أُغِٚ اُطجٚ٤ اُغٞداٚ٤ٗ Sudan Med J 2017 August;53(2):76-83 Original Article Antibiotics use in Inguinal hernia repair: a cross-sectional survey of participants at the 2014 West Africa College of Surgeon’s Conference in Ghana Amarachukwu C Etonyeaku, FWACS *, Elugbraonu A Agbakwuru, FMCS FWACS*, Olalekan Olasehinde, FWACS FMCS*, Ademola O Talabi, FMCS FWAC*, Oladapo A Kolawole, FWACS**, Akinbolaji A Akinkuolie, FWACS*, Julius G Olaogun FWACS*** Department of Surgery, Obafemi Awolowo University, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State Nigeria*, Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital Osogbo, Osun State Nigeria**, Ekiti State University Ado-Ekiti, Ekiti State Nigeria اطرخذاِاٌّضاداذاٌسُىَحفُئصﻻزاٌفرماﻹرتٍ :ِظسشاٍٍِعذجلطاعاذٍٍّشاروُٕفُّؤذّزوٍُحغزتأفزَمُاٌٍدزازٍُٕعاَ 2014 فُغأا. آشارشٌٞ ا٣ز٤ٗٞبًٞ, ا٣ِـجشاٞٗٝ اؿجوٞسٝ, اٝﻻ٤ٌُٖ اٝﻻع٤ٜ٘ذ١, ادٞٔ٣ﻻ رﻻث٢, ا٤ً٘جٞﻻع٢ ا٢ٌُٞ٘٤ً, هغٔبُغشاؽخ،عبؼٓخأٝثبك٤ٔ٤ؤُٝٞٝ،عبؼٓخأٝثبك٤ٔ٤ؤُٝٞٝٓغؼٔبُٔغزشل٤بربُز٤ٔ٤ِؼخ،ا٣َ-ا٣ق،ٝﻻ٣خأٝع٤٘ٗٞغ٤ش٣ب. اٝﻻدٝثًٞ ٞﻻ٢ُٝٝ, هغٔبُغشاؽخ،عبؼٓخﻻدًٝؤ٤ً٘زٞﻻُِزٌُٞٞ٘ع٤بٓغزشلىبُز٤ِؼٔؤٝعؿٞجٝ،ٞﻻ٣خأٝع٤٘ٗٞغ٤ش٣ب. أتظرزاوراٌخٍفُح:ٛ٘بًآساءٓزجب٣٘خٞؽﻻعزخذآبُٔعبدارب٣ٞ٤ؾُخك٤غشاؽخاُلزوبﻹسث٤ـ٤شؼٓوذح )اٛظ(. ك٤ؾ٤٘شأىجؼعبُغشا٤ؽ٘ؤٗبُٔعبدارب٣ٞ٤ؾُخ٤ُغزعشٝس٣خ،ٝدػبآخشٝٗﻻعزخذآٜبك٤بصﻻؽبرشجٌخكوػ . هٔ٘بثزو٤٤ٔٔٔبسعخاعزخذآبُٔعبدارب٣ٞ٤ؾُخك٤بٛغج٤٘بُٔشبس٤ً٘ل٤ٔئرٔشاُغشا٤ؽ٘ل٤ـشثؤكش٣و٤ب . اٌّىادواٌطزق:رٔزوذ٣ٔبعزج٤بٗزذاسرار٤باُىبُٔشبس٤ً٘بُز٣٘شبسًٞاك٤ٔئرٔش٤ًِخؿشثؤكش٣و٤بُِغشاؼِ٘٤ؽبّ 2014 كٌٞ٤ٓبع٢،ؿبٗب. كوطؤُٝئٌبُز٣٘ؤعشٝااٛغزٔبُ٘ظشكٜ٤ب. إٌرائح:أًَٔ 67 اعزج٤بٗباﻻعزج٤بٕ. ًبٗٔزٞعػ ٓذحأُٔبسعخاُغشا٤ؽخ 16.61 )± 9.96( ع٘خ. ًٝبٗبُٔغ٤ج٤٘٘ٔٗٞغ٤ش٣ب )ؿٝ )51بٗب )ٝ )10ثٖ٘ )2( ٝٝاؽذٌِٓ٘ٔ٘ـبٓج٤بٝع٤شا٤ُٞٗٞ٤ُجش٣بًٞٝرذ٣لٞاس. أٓباﻷؿِج٤خاُز٤زٔبسعل٤ٔغزشل٤بربُز٤ِؼٔبؼُب٢ُ )54( 80.6 ك٤بُٔبئخٝرئد١>5 اٛغشٜش٣ب 58.2 ك٤بُٔبئخ. اعزخذٓغؼ٤ٔبُٔغ٤ج٤٘ؤًضشٓ٘طش٣وخُﻹصﻻػ. ثبع٢٘٤ )ٕ = ٝ )34اُ٘بِٞ٣ٗبُشٕ )ٕ = 32( رو٤٘بربصﻻؽٌبٗزؤًضششؼج٤خ. ؼٓظٔبُٔغ٤ج٤ٖ )48( ٪71.6 رذاسأُعبدارب٣ٞ٤ؾُخك٤بٛغـ٤شؼٓوذح. ًٝبٜٗزاأعبعبداخﻻ٤ِٔؼُخ )ٝ ٪75 )36روزصش٠ِػ 24 عبػخٓ٘بُغشاؽخ )20( 41.7٪. ًبٗبﻻخزشاهبُٔشزجٜجٜل٤زؼو٤ْ )20( ٝ ٪41.7أُطِٞثؼِ٘ٔبؼُذٝىبُٞٔهؼبُغشا٢ؽ )18( 37.5٪ ًبٗزبﻷعجبثبُشئ٤غ٤خﻻعزخذآبُٔعبدارب٣ٞ٤ؾُخ. اخز٤بساُغشاٞؽٓذحاعزخذآبُٔعبدارب٣ٞ٤ؾُخًبٗزٔغزوِخػ٘ٔذحأُٔبسعخ،ٝاُٞٔهؼؤٝغجؼ٤خأُٔبسعخ،ٝر٤شحاٛغؤٝغش٣وخاصﻻؽبؼُٔزٔذح . ؼٓٝزُي،كبٗٔذحاعزخذآبُٔعبدارب٣ٞ٤ؾُخرؼزٔذػِىٞٔهؼبُٔٔبسعخ. اﻻطرٕراج: اعزخذآبُٔعبدارب٣ٞ٤ؾُخك٤بٛغـ٤شؼٓوذحٞٛشبئؼغذاثـعبُ٘ظشػ٘زو٤٘خاصﻻػ،اُخجشحك٤بٝ،َٔؼُاُٞٔهٞؼغجؼ٤خأُٔبسعخ . اُٞهب٣خٓ٘بؼُذٝىبُٞٔهؼبُغشاٜٞ٤ؽاُغججبُشئ٤غ٤ﻻعزخذاٚٓ. Abstract Background: There are divergent Materials & Methods: A self-administered opinions on the use of antibiotics in questionnaire was given to respondents who uncomplicated inguinal hernia surgery (IHS). were participants at the 2014 West African While some surgeons opined that antibiotics College of Surgeons‘ conference in Kumasi, are not necessary, others advocated its use in Ghana. Only those who performed IHS were meshbased repairs only. We evaluated the considered. practice of antibiotic use in IHS among Results: Sixty-seven respondents completed participants at a surgeons‘ conference in West the questionnaire. The mean duration of Africa. surgical practice was 16.61 (±9.96) years. ______________________________ Respondents were from Nigeria (51), Ghana Corresponding author (10), Benin (2) and one each from the Amarachukwu Chiduziem Etonyeaku Gambia, Sierra-Leone, Liberia, and Cote Tel: +234 8036369808 D‘Ivoire. Majority practiced at tertiary Email:[email protected] hospitals (54) 80.6% and performed <5 IHS Sudan Med J 2017 August;53(2) 76 Original Article Antibiotics use in Inguinal hernia repair Amarachukwu C Etonyeaku monthly 58.2%. All respondents used more infection in situations where chances of than one method of repair. Bassini (n=34) and infection occurring are high or the effect of its Nylon darn (n=32) repair techniques were occurrence is grave. In surgery, patients with more popular. Most respondents (48) 71.6% contaminated and dirty wounds are placed on administered antibiotics in uncomplicated therapeutic course of antibiotics. Those with IHS. This was mainly intra-operative (36) clean contaminated wound are offered 75% and limited to within 24hours of surgery prophylactic antibiotics; while clean (20) 41.7%. Suspected breach in asepsis (20) procedures generally do not require antibiotics 41.7% and desire to prevent surgical site administration. However, some otherwise infection (18) 37.5% were the major reasons clean procedures of the heart, brain and for antibiotics use. The surgeon‘s choice and surgeries involving insertion of implants duration of use of antibiotics were require antibiotics as any infection arising independent of the duration of practice, from these procedures may portend dare location or nature of practice, the frequency of consequences. IHS or repair method adopted. However, the In hernia surgery, presence of gangrenous duration of use of antibiotics was dependent contents of the hernia sac, obstructed viscus or on the location of practice. gut perforation necessitates the use of Conclusion: Antibiotics use in uncomplicated therapeutic doses of antibiotics. For IHS is very common irrespective of repair uncomplicated inguinal hernia repair technique, work experience, location and antibiotics are not generally required.(6) nature of practice. Prevention of surgical site However, some surgeons argue that in infection is the major reason for its use. meshbased repair, which is akin to implant Keywords: Hernia, antibiotics surgery, prophylactic antibiotics should be Introduction given to prevent infections.(7) Similarly, The surgeon through the years had to contend certain high risk patients for hernia repair are with three major challenges in the course of given antibiotic prophylaxis. These include: his/her duties. These challenges are: best the aged, immune-suppressed, obese, diabetic anaesthesia appropriate for a procedure and patients and those with recurrent disease and patient, best fit wound healing (scar less hypoproteinaemia.(8) When antibiotics are surgery) and prevention of surgical infections used, there would be need to determine the especially surgical site infections (SSI). There drug(s) of choice and duration of use. This had been steady advances in these frontiers study sought to evaluate the practice of over the years. Groin hernia surgery antibiotics use in groin hernia surgery epitomizes these advancements. Inguinal amongst surgeons who were participants at hernia repair has moved from a general the 2014 West African College of Surgeons‘ anaesthesia procedure through regional conference in Ghana, and to ascertain any anaesthesia and lately to local anaesthesia on a determinant that may influence the decision to day case basis.(1) Also with knowledge of skin use it. lines of tension,(2,3) better cosmesis is Materials & Methods achievable with appropriately placed incisions A confidential, self-administered and finesse in tissue dissection. Defective questionnaire on the use of antibiotics during wound healing, as may occur with surgical inguinal hernia repair was given to surgeons site infection, may herald recurrence,(4) while practicing in West Africa who attended the exuberant healing may lead to abnormal 2014 WACS conference in Kumasi, Ghana. scars.(5) Only questionnaires from those who perform Antibiotics use in clinical practice could either IHS were evaluated. be therapeutic or prophylactic. Therapeutic Respondents were given a single page use of antibiotics entails its use in the questionnaire containing 3 open ended treatment of established infections. questions (Location of practice, duration Prophylactic use connotes its use to prevent surgical practice and preferred antibiotics) and Sudan Med J 2017 August;53(2) 77 Original Article Antibiotics use in Inguinal hernia repair Amarachukwu C Etonyeaku 9 closed ended questions (Nature/type of and 71 were returned for review giving a practice, highest educational qualification; response rate of 97.3%. Of the 71 returned whether or not respondent perform inguinal questionnaires, 4 of them were from hernia surgery IHS, how frequent and type of respondents who did not undertake groin repair done, whether they would give hernia repair; and thus were excluded from antibiotics, and when it would be commenced further analysis. Thus 67 respondents were and for how long, and reasons for giving). considered eligible for further review, and Information obtained was then entered into a these comprised sixty-two consultant surgeons spread sheet and was analyzed using the (92.5%), one consultant family physician statistical package for the social sciences (1.5%), and four surgical residents (6%); one (SPSS) version 20 for frequencies, from Nigeria and three from Ghana. The mean percentages and statistical relationships using duration of surgical practice was 16.61 the chi square test; p values <0.05 were taken (±9.96) years (Range = 2−40 years). Their as significant. location and nature of practice are as shown in Results Table 1. Seventy-three questionnaires were administered, Table 1: Location and nature of practice of respondents. Nature of practice Location of Tertiary General / Primary Healthcare/ Private Public & Total (%) practice Hospital Specialist District Hospital Hospital Private (only) Hospital (only) (only) (only) Practice) Nigeria 40 5 0 4 2 51 Ghana 9 0 1 0 0 10 Gambia 1 0 0 0 0 1 Sierra Leone 1 0 0 0 0 1 Liberia 1 0 0 0 0 1 Cote D‘ivoire 1 0 0 0 0 1 Benin 1 0 1 0 0 2 TOTAL 54 5 2 4 2 67 (100) Thirty-nine (58.2%) respondents did an or
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