scholarly journals Why are we still using antibiotic prophylaxis in elective laparoscopic cholecystectomy for the low-risk groups? a review of literature

2021 ◽  
Vol 8 (2) ◽  
pp. 760
Author(s):  
Devajit Chowlek Shyam ◽  
Ranjit Chowlek Shyam ◽  
Donkupar Khongwar ◽  
Dathiadiam Tongper
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Port Site ◽  
Low Risk ◽  
Site Infection ◽  
Skin Preparation ◽  
Elective Laparoscopic Cholecystectomy

Gallstone disease is one of the most common gastrointestinal conditions requiring surgery and more than 90% of cholecystectomies are done laparoscopically. The major complications of laparoscopic cholecystectomy are major bleeding, Bile duct injury, and wound infection or surgical site infection. The incidence of Surgical site infection in laparoscopic cholecystectomy (0.4-1.13%) is significantly low compared to open cholecystectomy (3-47%) and the probable reasons are the smaller incision and the use of trocar along with almost nil to minimal wound contamination as compared to open cholecystectomy. Port site infection is a type of surgical site infection (1.8%) and the Umbilical port site is the most common site followed by the epigastric port site. In spite of the low-risk of surgical site infection, many surgeons still practice antibiotic prophylaxis in elective laparoscopic cholecystectomy for low-risk patients. Antibiotic prophylaxis is a debatable topic in the low-risk group undergoing elective laparoscopic cholecystectomy.Meticulous preoperative skin preparation is one of the established local factors to prevent the occurrence of SSI.

scholarly journals Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study

2020 ◽  
Vol 27 (4) ◽  
pp. E202043
Author(s):  
Aamir Hussain Hela ◽  
Haseeb Mohammad Khandwaw ◽  
Rahul Kumar ◽  
Mir Adnan Samad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Bile Duct ◽  
Surgical Site Infection ◽  
Tertiary Care Hospital ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Care Hospital ◽  
Site Infection ◽  
The Mean

Introduction: Laparoscopic cholecystectomy is the most commonly performed surgical procedure of digestive tract. It has replaced open cholecystectomy as gold standard treatment for cholelithiasis and inflammation of gallbladder.  It is estimated that approximately 90% of cholecystectomies in the  United States are performed using a laparoscopic approach.  The aim of this study was to evaluate the outcome of Laparoscopic cholecystectomy in context to its complications, morbidity and mortality in a tertiary care hospital.  Methods: This retrospective study was conducted on 1200 patients, who underwent laparoscopic cholecystectomies, during the period from January 2019 to December 2019, at Government Medical College Jammu J & K, India and necessary data was collected and reviewed. Results: In our study, a total of 1200 patients were studied including 216 males (18%) and 984 females (82%). The mean age of the patients was 43.35±8.61. The mean operative time in our study was 55.5±10.60 minutes with range of 45 – 90 minutes. Conversion rate was 2.6%. 2 patients were re-explored. Bile duct injury was found in 6 patients (0.5%).  Conclusions: Gallstone disease is a global health problem. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first choice of treatment for gallstones. Gall stone diseases is most frequently encountered in female population. The risk factors for conversion to open cholecystectomy include male gender, previous abdominal surgery, acute cholecystitis, dense adhesions and fibrosis in Calot’ s triangle, anatomical variations, advanced age, comorbidity, obesity, suspicion of common bile duct stones, jaundice, and decreased surgeon experience. The incidence of surgical site infection has significantly decreased in laparoscopic cholecystectomy compared to open cholecystectomy. In our study we could not find any case of surgical site infection.

Infection and Antimicrobial Use in Laparoscopic Cholecystectomy

1999 ◽  
Vol 20 (9) ◽  
pp. 624-626 ◽  
Author(s):  
Maryanne McGuckin ◽  
Judy A. Shea ◽  
J. Sanford Schwartz
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Chart Review ◽  
Antimicrobial Prophylaxis ◽  
Retrospective Chart Review ◽  
Low Risk ◽  
Antimicrobial Use ◽  
Site Infection ◽  
Surgical Site Infection Rate

AbstractRetrospective chart review of 1,702 patients undergoing laparoscopic cholecystectomy (LC) revealed an overall infection rate of 2.3% and a surgical-site infection rate of 0.4%. Preoperative antimicrobial prophylaxis was received by 79% of patients, but only 33% of these received the agent within 1 hour or less prior to surgery. These facts suggest that antimicrobial prophylaxis may not be necessary for low-risk LC patients.

scholarly journals ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING?

2016 ◽  
Vol 29 (3) ◽  
pp. 170-172 ◽  
Author(s):  
Márcio Alexandre Terra PASSOS ◽  
Pedro Eder PORTARI-FILHO
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Antibiotic Prophylaxis ◽  
Infectious Complications ◽  
Low Risk ◽  
Double Blind Study ◽  
Significant Difference ◽  
Risk Patients ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B

ABSTRACT Background: Elective laparoscopic cholecystectomy has very low risk for infectious complications, ranging the infection rate from 0.4% to 1.1%. Many surgeons still use routine antibiotic prophylaxis Aim: Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients. Method: Prospective, randomized and double-blind study. Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy divided in two groups: group A (n=50), patients that received prophylaxis using intravenous Cephazolin (2 g) during anesthetic induction and group B (n=50), patients that didn't receive any antibiotic prophylaxis. The outcome evaluated were infeccious complications at surgical site. The patients were reviewed seven and 30 days after surgery. Results: There was incidence of 2% in infection complications in group A and 2% in group B. There was no statistical significant difference of infectious complications (p=0,05) between the groups. The groups were homogeneous and comparable. Conclusion: The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients doesn't provide any significant benefit in the decrease of surgical wound infection.

scholarly journals A comparative study of open cholecystectomy and laparoscopic cholecystectomy in patients with cholelithiasis

2017 ◽  
Vol 5 (1) ◽  
pp. 253 ◽  
Author(s):  
Pramod Singh ◽  
Sumit Kumar Gupta ◽  
Mukesh Kumar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
City Hospital ◽  
Site Infection ◽  
First Choice ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Background: Cholelithiasis is a major cause of morbidity among Indians with a female preponderance. Most of the cases of gallstones are asymptomatic. For a long time, open cholecystectomy (OC) used to be the surgical treatment for cholelithiasis. But with the advent of laparoscopic cholecystectomy (LC) there has been a gradual shift in the treatment with most surgeons preferring LC over OC. Apart from the benefits of decreased hospital stay, lesser postoperative pain and earlier return to normal activity LC are also cosmetically better as compared to OC. Longer operative time and increased incidence of biliary leakage are some pitfalls of LC in initial phase of surgical practice.Methods: A prospective study of 100 patients was carried out in the department of surgery in IQ city medical college and Durgapur city hospital, Durgapur between January 2017 and August 2017 with the aim of comparing open cholecystectomy with laparoscopic cholecystectomy. The patients were randomly assigned into two groups. Group A consisted of patients who underwent laparoscopic surgery while Group B patients underwent open surgery for cholelithiasis.Results: Duration of surgery was longer in OC than LC (72.4min versus 44.7min.). Mean duration of post-operative pain was 18.3hrs in group A as compared to mean duration of 30.7hrs in group B patients. The mean period of post-operative hospital stay was 1.8 days in group A and 4.8 days in group B. Post-operative resumption of normal diet was possible in 2.1 days in OC while it took lesser time (1.2 days) in LC. The rate of surgical site infection was higher in OC as compared to LC.Conclusions: Laparoscopic cholecystectomy can be recommended as first choice operative treatment for patients with cholelithiasis as it provides better cosmetic results, lesser pain, lesser post-operative hospital stay and fewer incidence of surgical site infection.

scholarly journals Port Site and Intraperitoneal Infiltration of Local Anesthetics in Reduction of Postoperative Pain after Laparoscopic Cholecystectomy

1970 ◽  
Vol 22 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Mohammad Shaha Alam ◽  
Hasnat Waheedul Hoque ◽  
Mohammad Saifullah ◽  
Md Omar Ali
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Open Cholecystectomy ◽  
Early Postoperative Period ◽  
Port Site ◽  
Control Group ◽  
Time Interval ◽  
Narcotic Analgesics ◽  
Pain Scores ◽  
Elective Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is now the gold standard technique for the treatment of gallstones disease. Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort during the first 24 to 72 postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following laparoscopic cholecystectomy. Fifty patients undergoing elective laparoscopic cholecystectomy were consecutively included in this study and sample was divided into two groups. Following removal of gallbladder, Group A received 20 ml of 0.25% bupivacaine instilled in the right sub diaphragmatic space and 20 ml of 0.25% bupivacaine in divided doses at the trocar sites. The evaluation of postoperative pain was done at fixed time interval according to the numerical verbal scale and the dosage of narcotic analgesics consumed was also recorded. Mean pain scores at 6 hours and at 12 hours after surgery were 6.02 and 4.72 respectively, in the bupivacaine group compared with 8.44 and 6.08 respectively in the control group (p= <0.001 and <0.001). However, pain scores at 24 hours and 48 hours postoperatively and incidence of shoulder tip pain did not differ significantly between the two groups. The mean total narcotic analgesics used in study group was 1.91 as compared to 2.50 in the control group respectively and was found to be statistically significant (p= <0.001). Infiltration of bupivacaine in to port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective laparoscopic cholecystectomy.   DOI: 10.3329/medtoday.v22i1.5601 Medicine Today Vol.22(1) 2010. 24-28

scholarly journals 1137 Improving the Use of Pre-Operative Skin Antiseptics (Chlorhexidine Pink and Betadine) To Reduce Umbilical Port Site Infections Following Laparoscopic Cholecystectomy and Appendicectomy

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Adnan ◽  
S Sange ◽  
M Ahmed ◽  
S Kanchustambam
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Port Site ◽  
Site Infection ◽  
Surgical Team ◽  
Readmission Rates ◽  
Skin Preparation ◽  
Local Skin ◽  
Admission Rates ◽  
Post Surgery

Abstract Introduction Approximately 8% of patients who undergo laparoscopic surgery develop port site infections1. This would negatively impact recovery and increase rates of readmission. Patients’ skin is a major source of pathogens that results in surgical site infection (SSI). Therefore, optimisation of antiseptic skin preparations may decrease postoperative umbilical port site infection (UPSI). Method A retrospective analysis of 226 cases from August 2019 till October 2020 at East Lancashire Hospital NHS Trust was performed. The first cycle included 122 patients (58 cholecystectomies and 64 appendicectomies), and a further 104 patients (51 cholecystectomies and 53 appendicectomies) after emphasising on using chlorhexidine pink as skin preparation. The presence of UPSIs within 30 days post-surgery was recorded. Results In the first cycle, the local preparation that was used in patients with UPSI was chlorhexidine pink (21.4%) and betadine (78.6%). The surgical team were then educated regarding the benefits of chlorhexidine pink over betadine as local skin preparation. In the second cycle, 63.3% used chlorhexidine pink and 36.7% used betadine. After the above implementation, there was a reduction in the rate of UPSI (18.0% to 15.7%) and readmission rates (7.2% to 5.9%) in patients who had undergone laparoscopic cholecystectomy. In patients who had undergone laparoscopic appendicectomy, a similar trend in UPSI rates was identified as well (7.1% to 5.5%) and readmission rates (5.5% to 1.9%). Conclusions The incidence of UPSI was reduced with the use of chlorhexidine pink compared to betadine. This may have contributed to the decrease in UPSI cases and led to a reduction in re-admission rates.

scholarly journals Antibiotic prophylaxis in low risk patients undergoing laparoscopic cholecystectomy

2012 ◽  
Vol 7 (1) ◽  
pp. 12-18
Author(s):  
S Kumar ◽  
PJ Lakhey ◽  
P Vaidya ◽  
BN Patowary ◽  
CR Praveen ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Antibiotic Prophylaxis ◽  
Risk Group ◽  
Low Risk ◽  
Control Group ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B

Laparoscopic cholecystectomy is the 'gold standard' for benign diseases of gallbladder. It has rapidly gained popularity and it is one of the commonly performed operations in Nepal. The need for antibiotic prophylaxis when performing an elective laparoscopic cholecystectomy may not be as important as it is thought in low risk group. Despite, low postoperative infection rate in laparoscopic cholecystectomy in low risk group, the same criteria of antibiotic prophylaxis previously applied to conventional surgery are routinely used for laparoscopic surgery, even though its actual need has not been ascertained. Aim of this study was to assess the efficacy of antibiotic prophylaxis in elective laparoscopic cholecystectomy with respect to postoperative Surgical Site Infection (SSI) in low risk group. Study was carried out in The Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from May 2005 to June 2006 (14 months).This was a prospective randomized study done on 104 consecutive patients undergoing laparoscopic cholecystectomy. Patients were randomized into case group (group A) and control group (group B) with 52 patients in each group. Two and four patients from Group A and Group B respectively were excluded. In Group A, 50 patients received one gram ceftriaxone intravenously 30 minutes prior to induction of anesthesia and in Group B, all 48 patients received 10 milliliters (ml) of isotonic sodium chloride solution intravenously 30 minutes before induction. In both groups, age, sex, ultrasonogram findings, duration of surgery, American society of anesthesiologists patient classification score, antibiotic administration, bile spillage during surgery, length of postoperative hospital stay and postoperative SSI were recorded. Patients were advised to follow up in Surgical Out-patient Clinic if there was any evidence of SSI within 30 days. SSI was reported and classified as, superficial incisional, deep incisional or space / organ SSI. There were a total of 98 patients included in the study; 50 in Group A and 48 in Group B. In group A, three (6%) patients and in Group B, also three (6.3%) patients had superficial incisional SSI. None of them had deep or organ / space SSI. Comparison of data showed no statistically significant difference between two groups (P- 1.00). DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5962 JCMSN 2011; 7(1): 12-18

Comparison of the Risk of Surgical Site Infection After Laparoscopic Cholecystectomy and Open Cholecystectomy

2007 ◽  
Vol 28 (9) ◽  
pp. 1103-1106 ◽  
Author(s):  
Fernando M. Biscione ◽  
Renato C. Couto ◽  
Tânia M. Pedrosa ◽  
Mozar C. Neto
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Site Infection ◽  
Lower Risk ◽  
Open Cholecystectomy ◽  
Infection Risk ◽  
Surgical Patient ◽  
Site Infection ◽  
Space Infection ◽  
Organ Space Infection ◽  
Reduced Risk

We assessed the independent contributions of the surgical approach and other variables of the National Nosocomial Infections Surveillance System (NNIS) surgical patient component to the surgical site infection risk after cholecystectomy. Laparoscopic cholecystectomy was associated with a lower overall risk of surgical site infection and a lower risk of incisional infection but not a reduced risk of organ-space infection, compared with open cholecystectomy. The contribution of most of the variables of the NNIS surgical patient component to the risk of surgical site infection depended on the depth of the infection.

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