***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 A prospect i ve study was carried out to determine the incidence of  wound infection following surgery for inguinal hernia repair in a day surgery unit . The study incorporated surveillance for 1 month postoperatively . All patients were contacted by telephone , and reports of possible wound infection investigated via their General Practitioners . Ninety-seven patients were included in the study and the infection rate was 4 % 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 OBJECTIVE There are controversies about the benefits of prophylactic antibiotics in the prevention of postoperative surgical site infection ( SSI ) in mesh herniorrhaphy for a long time . This study aim ed to evaluate the effectiveness and efficacy of systemic prophylactic cefazolin in prevention of wound infection in various types of hernia repair with mesh material s. METHODS This is a prospect i ve r and omized control study . We evaluated wound infection rates in 395 patients with various kinds of hernia who underwent elective mesh repair using polypropylene mesh from 2007 to 2011 . A total of 237 ( 60.0 % ) patients received prophylactic cefazolin ( study group ) and the remaining 158 ( 40.0 % ) patients did not receive any prophylactic antibiotics ( control group ) . Patients were followed for infection at the following periods after the operation by an independent surgeon : 10 days , 30 days , 12 months , and then annually for at least 2 years . RESULTS Eight ( 2.03 % ) patients had infection in the site of surgery [ 2 ( 1.27 % ) in the control group and 6 ( 2.53 % ) in the study group ] . The distribution of infection was not significantly different between the two groups ( p = 0.364 ) . The superficial infections were managed by drainage and irrigation . One patient from the study group developed deep SSI and was readmitted and subsequently received antibiotic therapy , drainage , and debridement . CONCLUSION Preoperative administration of single-dose cefazolin for prosthetic hernia repairs did not markedly decrease the risk of wound infection . Our results do not support the use of cefazolin as a prophylactic antibiotic for various kinds of abdominal wall hernia repair with mesh A controlled r and omized trial was carried out in 324 patients with inguinal hernia .  Efficacy was evaluated of a single injection of cefam and ole ( n = 162 ) administered at operative site during local anesthesia , using an untreated group as control ( n = 162 ) , as prophylaxis against post-operative local infection . Seven patients in the control group developed abscesses at the operative site after discharge , 6 of the 7 during one-month follow up , compared with none in the treated group ( n = 0.07 ) . No side effects were reported due to the antibiotic therapy . The cost of the antibiotic treatment was 10 times less than that for treating the suppurations in the control group 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 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 BACKGROUND Prophylactic antibiotics are recommended for clean-contaminated and selected contaminated surgery . In clean surgery antibiotics are suggested if the operation involves the insertion of prosthetic devices and a potential infection is expected to cause serious morbidity or mortality . Inguinal hernia repair is a clean operation , infections are rare ; they can usually be cured without removing the prosthesis and recurrence is uncommon even after removal of the mesh . Aim of the study is to evaluate whether the lack of antimicrobial prophylaxis increases the risk of postoperative infections in patients treated for groin hernia , compared to those treated with prophylaxis . METHODS One hundred and forty-eight patients underwent inguinal hernia repair with mesh : 64 patients ( 43 % ) received 2 g cefotaxime by intravenous bolus about 30 minutes before the operation , 84 patients ( 57 % ) did not receive any antimicrobic prophylaxis . Mean follow-up was 13 months ( range 1 - 31 months ) for both groups . RESULTS We did not observe any major complication . Among both groups , no patient had developed infection at one week and one month after surgery . CONCLUSIONS In personal experience , any advantage in terms of prevention of infections with antibiotic prophylaxis in patients operated on for groin hernia has been observed . A review of the literature showed no general agreement on this subject with different risk of infections in different trials . A new prospect i ve r and omized trial is necessary to clarify this topic A study was made of the risk factors causing a high incidence of  surgical wound infections in clean operations . Identification of these factors in the preoperative stage allows the patients to be divided into two categories : a high risk ( about 10 % of patients for surgery ) and low risk . By giving antibiotic prophylaxis only to patients at high risk , the incidence of postoperative infections can be reduced , decreasing the number of extra days in hospital and consequently lowering costs . This is a new approach to the problem of surgical wound infections since not only is it based on the usual classification of operations into clean , clean-contaminated , contaminated and dirty , but it also takes into account the defensive capacity of the target of the infection : the patient Objective : To assess the long-term crossover ( CO ) rate in men undergoing watchful waiting ( WW ) as a primary treatment strategy for their asymptomatic or minimally symptomatic inguinal hernias . Background : With an average follow-up of 3.2 years , a r and omized controlled trial comparing WW with routine repair for male patients with minimally symptomatic inguinal hernias led investigators to conclude that WW was an acceptable option [ JAMA . 2006;295(3):28 
    Output:
    
Subgroup analysis did not change these results .
Evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces the risk of postoperative wound infections after herniorrhaphy surgery .
Evidence of moderate quality shows that antibiotic prophylaxis probably makes little or no difference in preventing wound infections ( i.e. all wound infections , SSSI or DSSI ) after hernioplasty surgery in a low infection risk environment .
Evidence of low quality shows that antibiotic prophylaxis in a high-risk environment may reduce the risk of all wound infections and SSSI , while evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces DSSI after hernioplasty surgery