Laparoscopic Cholecystectomy Without Prophylactic Antibiotics: A Prospective Study

Abstract

Laparoscopic cholecystectomy has become the new gold standard for management of symptomatic gallstones. Prophylactic antibiotics are used in elective surgery by the majority of surgeons, and their role in biliary tract surgery has been well established for a subpopulation of high-risk patients. This consensus has been derived from multiple studies involving biliary tract surgery before and in the era of laparoscopic cholecystectomy. But the use of prophylactic antibiotics in laparoscopic cholecystectomy especially in the lowrisk group is now controversial and varied among the surgeons all over the world. To study the role of prophylactic antibiotics in laparoscopic cholecystectomy in different risk groups of patients, a prospective study was conducted in the Department of Surgery of Bankura Sammilani Medical College and Hospital from January 2010 to July 2011. All patients with symptomatic gallstones who underwent elective laparoscopic cholecystectomy during this period are included in this study. One hundred and two patients with symptomatic gallstones were operated on by laparoscopic technique without receiving preoperative antibiotics and studied over a period of 1.5 years. Ages ranged from 11 to 70 years (mean age of 33 years). There were 14 males (13.72 % of the patients) and 88 females (86.27 % of the patients). There was no wound infection (class I) in 99 patients, and class II type of wound infection, i.e., surgical site infection, occurred in three patients (i.e., 2.94 %) out of a total of 102 patients. Swabs were taken for culture and sensitivity; Staphylococcus aureus was found in two patients and Streptococcus viridans in one patient. In all three patients, infection occurred at the umbilical port sites, detected on the 3rd and 4th postoperative days. Antibiotic prophylaxis is not necessary in low-risk patients with symptomatic gallstone disease undergoing elective laparoscopic cholecystectomy to prevent postoperative infection-related complications. Preoperative skin preparation with chlorhexidine gluconate scrub may replace the use of prophylactic antibiotics for prevention of infection-related complications in patients undergoing elective laparoscopic cholecystectomy.

Pre-operative anti-microbial administration for prevention of post-operative infections in patients with open cholecystectomy and laparoscopic cholecystectomy

“…6 Many studies revealed that women of age group above 20 years are most likely affected with cholecystitis. 3,5 This was in accordance with the present study findings. About 14 females of age group between 21-30years were affected in this study.…”

“…Open cholecystectomy is the most important technique, but laparoscopic cholecystectomy is now the gold standards due to its advantages like less invasive and less tissue involvement. 5 Prophylactic use of antibiotics is an important component of biliary tract surgery, and there is about 50% decrease in the incidence of postoperative wound infection with the use of preoperative antibiotics. 6 Many studies revealed that women of age group above 20 years are most likely affected with cholecystitis.…”

The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial

“…9 High-risk LC patients are identified as follows: patients over 60 years of age; those with a history of diabetes, immunosuppression, biliary stones and obstruction, cholangitis, or jaundice; patients with a history of colic within 30 days before surgery; patients with cholecystitis at the time of surgery; and patients with a history of previous biliary surgery. 18 A study conducted on 277 patients undergoing LC 19 and another study that examined 1037 patient 6 reported that there was no statistically significant effect of prophylactic antibiotic use prior to low-risk LC on the development of postoperative infection. All of these meta-analyses reported that there was no difference between the prophylactic group and the non-prophylactic group in terms of infection and that it was therefore not necessary to apply prophylaxis before low-risk LC.…”

“…1,[13][14][15][16][17] In another study where LC was performed on 102 patients and prophylactic antibiotics were not applied, it was concluded that prophylactic antibiotic use before low-risk LC was not necessary. 18 A study conducted on 277 patients undergoing LC 19 and another study that examined 1037 patient 6 reported that there was no statistically significant effect of prophylactic antibiotic use prior to low-risk LC on the development of postoperative infection. In a study of 429 patients who underwent low-risk LC, the rate of infection was 1.7% and 2.1% in 182 patients with prophylaxis and 247 patients without prophylaxis, respectively; however, no statistically significant difference was found.…”

Ocorrência e fatores de risco de infecção de sítio cirúrgico em colecistectomia videolaparoscópica

“…O controle glicêmico perioperatório reduz o risco de ISC, mortalidade e tempo de internação hospitalar(FREITAS et al, 2013). durante o ato cirúrgico, foi considerada como fator de risco para o aumento das chances de desenvolvimento de ISC em cirurgias de colecistectomia videolaparoscópica, e os dados foram pautados em relatos de série de casos de abscessos contendo cálculos biliares em seu interior(HORTON; FLORENCE, 1998) FREIER, ALBEAR, 1999;CHONG et al, 2015;MANDAL et al, 2015;PASQUALI et al 2016)…”