***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The European Hernia Society ( EHS ) is proud to present the EHS Guidelines for the Treatment of  Inguinal Hernia in Adult Patients . The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare . They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS . They are evidence -based and , when necessary , a consensus was reached among all members . The Guidelines have been review ed by a Steering Committee . Before finalisation , feedback from different national hernia societies was obtained . The  Appraisal of Guidelines for REsearch and Evaluation ( AGREE ) instrument was used by the Cochrane Association to vali date the Guidelines . The Guidelines can be used to adjust local protocol s , for training purpose s and quality control . They will be revised in 2012 in order to keep them up date d. In between revisions , it is the intention of the Working Group to provide every year , during the EHS annual congress , a short up date of new high-level evidence ( r and omised controlled trials [ RCTs ] and meta-analyses ) . Developing guidelines leads to questions that remain to be answered by specific research . Therefore , we provide recommendations for further research that can be performed to raise the level of evidence concerning certain aspects of inguinal hernia treatment . In addition , a short summary , specifically for the general practitioner , is given . In order to increase the practical use of the Guidelines by consultants and residents , more details on the most important surgical techniques , local infiltration anaesthesia and a patient information sheet is provided . The most important challenge now will be the implementation of the Guidelines in daily surgical practice . This remains an important task for the EHS . The establishment of an EHS school for teaching inguinal hernia repair surgical techniques , including tips and tricks from experts to overcome the learning curve ( especially in endoscopic repair ) , will be the next step . Working together on this project was a great learning experience , and it was worthwhile and fun . Cultural differences between members were easily overcome by educating each other , respecting different views and always coming back to the principles of evidence -based medicine . The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project BACKGROUND Inguinal hernia is the commonest type of external hernias . Lichtenstein mesh repair is the most favoured technique of inguinal hernia repair nowadays . It is tension free repair of weakened inguinal wall using polypropylene mesh . The present study was conducted to determine the efficacy of single dose antibiotic with placebo on patients undergoing inguinal hernia mesh repair . METHODS This r and omised controlled trial was carried out in the Department of General Surgery , Ayub Teaching Hospital , Abbottabad from January to December 2011 . The study population included male patients presenting with primary unilateral inguinal hernia , above 18 years of age .  Mesh repair was performed in all patients . The patients were r and omly divided into two groups . Patients in group A were given a single dose of antibiotic before inguinal hernia mesh repair and patients in group B were given placebo before inguinal hernia mesh repair . Efficacy of antibiotic and placebo was accessed in terms of surgical site infections ( SSIs ) . RESULTS A total of 166 cases of inguinal hernia mesh repair patients were recorded during the study period . A total of 83 patients were recruited in each group .  Surgical site infection was found in 6 ( 7.2 % ) in Group B it was 15 ( 18.1 % ) . The difference being statistically significant ( p = 0.036 ) . CONCLUSION Antibiotic prophylaxis is a preferred option for mesh plasty Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more In a series of 762 general surgical wounds 376 were selected at r and om to receive three parenteral doses of cephaloridine and 386 remained as untreated controls . In all types of operation , with the exception of wounds in the lower extremities associated with arterial surgery , the rate of wound infection was lowered by the prophylactic use of cephaloridine . The results were statistically significant for total wounds , clean wounds , total contaminated wounds , and contaminated wounds other than in colorectal surgery . We therefore recommend the routine use of three doses of cephaloridine Purpose Evidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection  in adult inguinal hernia repair is conflicting . A recent Cochrane review based on 17 r and omised trials did not reach a conclusion on this subject . This study aim ed to describe the current practice and determine whether clinical equipoise is prevalent . Methods Surgeons in training were recruited to administer the Survey of Hernia Antibiotic Prophylaxis usE survey to consultant-level general surgeons in London and the south-east of Engl and on their practice s and beliefs regarding antibiotic prophylaxis in adult elective inguinal hernia repair . Local prophylaxis guidelines for the participating hospital sites were also determined . Results The study was conducted at 34 different sites and received completed surveys from 229 out of a possible 245 surgeons , a 93 % response rate . Overall , a large majority of hospital guidelines ( 22/28 ) and surgeons ’ personal beliefs ( 192/229 , 84 % ) supported the use of  single-dose pre-operative intravenous antibiotic prophylaxis  in inguinal hernia repair , although there was considerable variation in the regimens in use . The most widely used regimen was intravenous co-amoxiclav ( 1.2 g ) . Less than half of surgeons were adherent to their own hospital antibiotic guidelines for this procedure , although many incorrectly believed that they were following these . Conclusion In the south-east of Engl and , there is a strong majority of surgical opinion in favour of the use of antibiotic prophylaxis in this procedure . It is therefore likely to be extremely difficult to conduct further r and omised studies in the UK to support or refute the effectiveness of prophylaxis in this commonly performed procedure Abstract . Antibiotic prophylaxis is not routinely given for nonimplant , clean operations , although this view has recently been challenged . We have conducted a r and omized multicenter , double-blind prospect i ve trial to compare co-amoxiclav with placebo in 619 patients undergoing open groin hernia repair . Altogether 563 ( 91 % ) patients fulfilled the protocol ; 283 received co-amoxiclav  and 280 placebo . There was no difference between the groups in the number of patients receiving local or general anesthetic , the type of repair performed , the use of a subcutaneous fat suture , the type of skin closure used , the use of wound analgesia , or the use of a wound drain . Patients were given a card to return to the hospital in the event of their wound discharging or their needing to see their general practitioner . All patients were review ed at approximately 6 weeks after operation . Fifty ( 8.9 % ) patients sustained a wound infection , 25 in the co-amoxiclav group and 25 in the placebo group . We conclude that antibiotic prophylaxis is of no benefit to patients undergoing open groin hernia repair Objective To assess the value of single-dose , intravenous , prophylactic ampicillin and sulbactam ( AS ) in the prevention of wound infections during open prosthetic inguinal hernia repair by a double-blind , prospect i ve , r and omized trial . Summary Background Data The use of antibiotic prophylaxis during open prosthetic inguinal hernia surgery is controversial , and no prospect i ve trial has been conducted to examine this issue . Methods Patients undergoing unilateral , primary inguinal hernia repair electively with the Lichtenstein technique using polypropylene mesh  were r and omized to receive 1.5 g intravenous AS before the incision or an equal volume of placebo according to a predetermined code of which the surgeons were unaware . Patients with recurrent , femoral , bilateral , giant , or incarcerated hernias or any systemic diseases were excluded . Age , sex , body mass index , American Society of Anesthesiologists score , type of hernia , type of anesthesia , duration of surgery , and use of drains were recorded . Infection was defined according to the criteria of Centers for Disease Control . Patients were evaluated 1 week , 1 month , 6 months , and 1 year after surgery by an independent surgeon . All complications were recorded . Results were assessed using chi-square , Fisher ’s exact , and Student t tests as appropriate . Results Between September 1996 and July 1998 , 280 patients ( 140 AS , 140 placebo group ) entered the protocol . Four patients from the AS group and seven from the placebo group were excluded because of inadvertent antibiotic administration or follow-up problems . Groups were well matched for all the variables studied and postoperative complications , excluding wound infections , which occurred at a rate of 0.7 % in the AS group and 9 % in the placebo group ( P = .00153 ) . Twelve patients in the placebo group developed wound infections , requiring five repeat hospital admissions in three patients . These three patients suffered deep infections reaching the graft , which result ed in graft loss in two . The single infected patient in the AS group had his graft removed as well because of deep persistent infection . Conclusions This study documented a significant ( 10-fold ) decrease in overall wound infections when single-dose , intravenous AS was used during Lichtenstein hernia repair . Deep infections and wound infection-related readmissions were also reduced by the use of AS . Proponents of mesh repairs may therefore be advised to use prophylactic single-dose intravenous antibiotic coverage in the light of the results of this trial . AS proved to be an effective antimicrobial agent Mesh prosthesis , local anesthesia , and ambulatory care have been widely introduced in recent decades in the treatment of inguinal hernia .  The use of antibiotic prophylaxis during open inguinal hernia repair has been controversial . No prospect i ve trial has been conducted to assess the role of antibiotic prophylaxis in patients operated on for inguinal hernia under the above-mentioned conditions . A prospect i ve , r and omized , double-blinded trial was initiated to assess the efficacy of antibiotic prophylaxis in the prevention of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis . Ninety-nine consecutive hernia repairs were r and omized to receive 1 g of parenteral Cefazolin preoperatively or a placebo . No wound infections existed in the therapeutic group ( 0/50 ) . Four infections appeared in the control group ( 4/49 ) , and the study was suspended for ethical reasons when differences reached values close to statistical significance ( P=0.059 ) . We conclude that a single dose of intravenous Cefazolin decreases the risk of wound infection during open mesh inguinal hernia repair under local anesthesia on an ambulatory basis Objective : To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair . Summary Background Data : A recent Cochrane meta- analysis ( 2003 ) concluded that “ antibiotic prophylaxis for elective inguinal hernia repair can not be firmly recommended or discarded . ” Methods : Patients with a primary inguinal hernia scheduled for Lichtenstein repair were r and omized to a preoperative single dose of 1.5 g intravenous cephalosporin or a placebo .  Patients with recurrent hernias , immunosuppressive diseases , or allergies for the given antibiotic were excluded . Infection was defined using the Centers for Disease Control and Prevention criteria . Results : We included 1040 patients in the study between November 1998 and May 2003 . According to the intention-to-treat principle , 1008 patients were analyzed . There were 8 infections ( 1.6 % ) in the antibiotic prophylaxis group and 9 ( 1.8 % ) in the placebo group ( P = 0.82 ) . There was 1 deep infection in the antibiotic prophylaxis group and 2 in the placebo group ( P = 0.57 ) . Statistical analysis showed an absolute risk reduction of 0.19 % ( 95 % confidence interval , −1.78%–1.40 % ) and a number needed to treat of 520 for the total number of infections . For deep infection , the absolute risk reduction is 0.20 % ( 95 % confidence interval , −0.87%–0.48 % ) with a number needed to treat of 508 . Conclusions : A low percentage ( 1.7 % ) of wound infection after Lichtenstein open mesh inguinal ( primary ) hernia repair was found , and there was no difference between the antibiotic prophylaxis or placebo group . The results show that , in Lichtenstein inguinal primary hernia repair , antibiotic prophylaxis is not indicated in low-risk patients Hernia repair is one of the so-called clean operations . Many surgeons , however , use antibiotics , especially in the mesh repair era , without strong evidence to support this policy . We conducted a single-centre prospect i ve r and omised trial with a view to clarify this issue on a scientific basis . From January 
    Output:
    
SUCRA results indicated that β‐lactam/β‐lactamase inhibitors and first‐generation cephalosporins were ranked first and second respectively for best prophylaxis .
Conclusion : β‐Lactam/β‐lactamase inhibitors followed by first‐generation cephalosporins ranked as the most effective SSI prophylaxis for adult patients undergoing groin hernia repair