Single Dose vs Multiple Dose Prophylactic Antibiotic to Prevent Early Port-Site Infection in Elective Laparoscopic Cholecystectomy

Background: The major crisis in any type of surgery is understood to be Surgical Site Infection (SSI). Although laparoscopic cholecystectomy is a nominally invasive procedure, there is a dominant prevalence of SSI in patients. It is also believed that prophylactic antibiotic has major impact in reducing SSI. Subjects & Methods: Seventy cases were enrolled in this study with knowledgeable consent. The study was carried out over a time period of ten months. The subjects acknowledge for elective laparoscopic cholecystectomy were incorporated in our study. Results: Out of the 70 randomized patients, 35 were allotted in single dose (SD group) while 35 patients were allotted in multiple doses (MD group), who got planned treatments and were then investigated. Of the 70 patients, female patients were 58(82.9%) and males were 12(17.1%). Total 43.62 12.18 years was the mean age of patients having symptomatic cholelithiasis, with 18 years as minimum and 77 years as maximum age. The peak of disease was documented in the age group of 30 to 39 years (28.6%). Conclusion: Utility of single antibiotic dose before anesthesia induction in laparoscopic cholecystectomy was likewise efficient as the use of multiple antibiotics doses in surgical site infection of postoperative periods.

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Prophylactic Antibiotics in Elective Laparoscopic Cholecystectomy is it Necessary?

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v16i2.24866 ◽

2018 ◽

Vol 16 (2) ◽

pp. 16-18

Author(s):

Anup Sharma ◽

Arun Shah

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Dose ◽

Surgical Site Infection ◽

Prophylactic Antibiotic ◽

Prophylactic Antibiotics ◽

Site Infection ◽

Medical College ◽

Group A ◽

Elective Laparoscopic Cholecystectomy ◽

Group B

Background: Elective laparoscopic cholecystectomy (LC) has a low risk for Surgical Site Infection (SSI). In spite many surgeons still use prophylactic antibiotics. The aim of this study was to find out the need of prophylactic antibiotics in elective LC. Method: This study was carried out from 2017 June to 2018 August in the Department of Surgery Nepalgunj Medical College and Teaching Hospital Kohalpur (NGMC). Patients were placed into two groups. Group A received a single dose of prophylactic antibiotic and group B patients did not receive any prophylactic antibiotic. In both groups the SSI were recorded and compared. Results: Overall SSI was 5(3.33%) among 150. In group A 2 (2.66%) patients had SSI and in group B 3 (4%) had SSI. Using or not using prophylactic antibiotics did not correlate with SSI (p= .154). Conclusions: Prophylactic antibiotic is not recommended in elective LC. Prophylactic antibiotic does not reduce the rate of SSI.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20210401 ◽

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.

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Single dose versus multiple dose prophylactic antibiotic in laparoscopic cholecystectomy: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20161135 ◽

2016 ◽

pp. 633-636

Author(s):

Pinakin Sutariya ◽

Pukur Thekdi

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Dose ◽

Comparative Study ◽

Multiple Dose ◽

Prophylactic Antibiotic

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A STUDY OF PORT SITE INFECTION AFTER LAPAROSCOPIC CHOLECYSTECTOMY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i3.1820 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Mahesh Joshi ◽

Prama Dubey

Keyword(s):

Laparoscopic Cholecystectomy ◽

Quality Of Healthcare ◽

Port Site ◽

Site Infection ◽

Proper Selection ◽

Basic Principles ◽

Elective Laparoscopic Cholecystectomy ◽

Selection Of Patients ◽

Selection Of

Background: Port site infections though rare, shall be evaluated and studied so as to improve the quality of healthcare. Materials and Methods: This prospective study was conducted on100 patients of all age group and both sexes with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy were analysed for port site infection. Result: Out of 100 patients studied only 3 patients presented with port site infection. Conclusion: It is concluded that port site infection are rare in elective laparoscopic cholecystectomy and can be further reduced by proper selection of patients, and strictly following basic principles of laparoscopic cholecystectomy Keywords: Port site infection, laparoscopic, Cholecystectomy

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Single dose Intraoperative Antibiotics versus Postoperative Antibiotics for Patient Undergoing Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis

Journal of Lumbini Medical College ◽

10.22502/jlmc.v0i0.112 ◽

2017 ◽

pp. 5

Author(s):

Sagun Bahadur Thapa ◽

Yashwant Ramakrishan Kher ◽

Yashwant Gajanan Tambay

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Dose ◽

Surgical Site Infection ◽

Hospital Stay ◽

Prophylactic Antibiotic ◽

College Teaching ◽

Intravenous Dose ◽

Site Infection ◽

Symptomatic Cholelithiasis ◽

The Difference

Introduction: Surgical site infection is a common complication shown in literature following cholecystectomies. Smaller incision and use of trocars in laparoscopic cholecystectomy lessen the contamination resulting in less chances of surgical site infection. However, in fear of postoperative infection, many opt for the prolonged postoperative use of antibiotic and there is growing consensus against it. Antibiotics not only increases the cost and hospital stay duration but it aids in emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial to see whether a single prophylactic dose of antibiotic at the time of induction of anesthesia for laparoscopic cholecystectomy was equally effective in controlling post-operative infection as multi-dose antibiotics during and post-operative period. Methods: The study was conducted at the department of general surgery, Lumbini Medical College Teaching Hospital, from November 2015 to October 2016. All cases with symptomatic cholelithiasis subjected for laparoscopic cholecystectomy were enrolled. Patients were randomized into two groups; Group SD received single dose of an intravenous dose of amikacin 500 mg, at induction of anesthesia and Group MD received multiple intravenous dose of amikacin, during and postoperatively for two days. Complications, hospital stay, and treatment cost in two groups were compared and analyzed. Results: There were a total of 240 patients in the study, 118 in Group SD and 122 in Group MD. Post-operative infection rate was 4.2% (n= 5, N=118) in Group SD and 3.3% (n=4, N=122) in Group MD; the difference was not significant (p=0.75). Hospital stay was prolonged and cost was higher significantly in Group MD. Conclusion: Single dose of prophylactic antibiotic, administered at induction of anesthesia, is equally effective as multiple doses of post surgical antibiotics to prevent post-operative infection in patients undergoing elective laparoscopic cholecystectomy for uncomplicated cholelithiasis.

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Single dose versus multiple dose antibiotics in laparoscopic cholecystectomy: A prospective comparative single blind study

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v5i1.23212 ◽

2019 ◽

Vol 5 (1) ◽

pp. 11-15

Author(s):

Ashok Koirala ◽

Dipendra Thakur ◽

Sunit Agrawal ◽

Bhuwan Lal Chaudhary

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Dose ◽

Surgical Site Infection ◽

Multiple Dose ◽

Randomized Study ◽

Prophylactic Antibiotics ◽

Site Infection ◽

Medical College ◽

Symptomatic Cholelithiasis ◽

Multiple Doses

Introduction: There is a controversy on single dose or multiple doses of prophylactic antibiotics for prevention of surgical site infection during laparoscopic cholecystectomy in a developing country setting. The objective of this study was to compare single versus multiple doses of prophylactic antibiotics in terms of surgical site infection in laparoscopic cholecystectomy patients. Methods: This was a prospective, comparative, randomized study was conducted in a medical college hospital. Two hundred consecutive patients with symptomatic cholelithiasis planned for routine laparoscopic cholecystectomy were enrolled in the study. Patients were randomly divided in a Single dose (SD) group and multiple dose (MD) group. SD group were given injection ceftriaxone (1gm) before induction of anesthesia and MD group received ceftriaxone (1gm) before induction of anesthesia and continued a total of 3 doses postoperatively for next 24 hours. Results: A total of 200 patients were studied, of which 100 were in single dose (SD group) and another 100 in multiple dose (MD group). The mean age of patients with symptomatic cholelithiasis was 41.76 ± 13.38 years with minimum of 16 years and maximum of 73 years. Of the total patients, 4 patients in single dose (SD) group and 3 patients in multiple dose (MD) group developed surgical site infection of various severity which was not statistically significant. (p=0.500). Conclusion: There is no difference in terms of surgical site infection in patients taking either single or multiple doses of antibiotics in laparoscopic cholecystectomy in a medical college setting in Nepal.

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Single dose Intraoperative Antibiotics versus Postoperative Antibiotics for Patient Undergoing Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis

Journal of Lumbini Medical College ◽

10.22502/jlmc.v5i1.112 ◽

2017 ◽

Vol 5 (1) ◽

pp. 13

Author(s):

Sagun Bahadur Thapa ◽

Yeshwant Ramakrishna Kher ◽

Yashwant Gajanan Tambay

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Dose ◽

Surgical Site Infection ◽

Hospital Stay ◽

Prophylactic Antibiotic ◽

College Teaching ◽

Intravenous Dose ◽

Site Infection ◽

Symptomatic Cholelithiasis ◽

The Difference

Introduction: Surgical site infection is a common complication shown in literature following cholecystectomies. Smaller incision and use of trocars in laparoscopic cholecystectomy lessen the contamination resulting in less chances of surgical site infection. However, in fear of postoperative infection, many opt for the prolonged postoperative use of antibiotic and there is growing consensus against it. Antibiotics not only increases the cost and hospital stay duration but it aids in emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial to see whether a single prophylactic dose of antibiotic at the time of induction of anesthesia for laparoscopic cholecystectomy was equally effective in controlling post-operative infection as multi-dose antibiotics during and post-operative period. Methods: The study was conducted at the department of general surgery, Lumbini Medical College Teaching Hospital, from November 2015 to October 2016. All cases with symptomatic cholelithiasis subjected for laparoscopic cholecystectomy were enrolled. Patients were randomized into two groups; Group SD received single dose of an intravenous dose of amikacin 500 mg, at induction of anesthesia and Group MD received multiple intravenous dose of amikacin, during and postoperatively for two days. Complications, hospital stay, and treatment cost in two groups were compared and analyzed. Results: There were a total of 240 patients in the study, 118 in Group SD and 122 in Group MD. Post-operative infection rate was 4.2% (n= 5, N=118) in Group SD and 3.3% (n=4, N=122) in Group MD; the difference was not significant (p=0.75). Hospital stay was prolonged and cost was higher significantly in Group MD. Conclusion: Single dose of prophylactic antibiotic, administered at induction of anesthesia, is equally effective as multiple doses of post surgical antibiotics to prevent post-operative infection in patients undergoing elective laparoscopic cholecystectomy for uncomplicated cholelithiasis.

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Review of Perioperative Prophylactic Antibiotic Use during Laparoscopic Cholecystectomy and Subsequent Surgical Site Infection Development at a Single Children's Hospital

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1740461 ◽

2021 ◽

Author(s):

Kayla B. Briggs ◽

James A. Fraser ◽

Wendy Jo Svetanoff ◽

Jessica K. Staszak ◽

Charles L. Snyder ◽

...

Keyword(s):

Antibiotic Resistance ◽

Laparoscopic Cholecystectomy ◽

Surgical Site Infection ◽

Clinical Signs ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Site Infection ◽

Intravenous Antibiotics ◽

Elective Laparoscopic Cholecystectomy ◽

Preoperative Work Up

Abstract Objectives With the rise of antibiotic resistance, the use of prophylactic preoperative antibiotics (PPA) has been questioned in cases with low rates of surgical site infection (SSI). We report PPA usage and SSI rates after elective laparoscopic cholecystectomy at our institution. Materials and Methods A retrospective review of children younger than 18 years who underwent elective outpatient laparoscopic cholecystectomy between July 2010 and August 2020 was performed. Demographic, preoperative work-up, antibiotic use, intraoperative characteristics, and SSI data were collected via chart review. SSI was defined as clinical signs of infection that required antibiotics within 30 days of surgery. Results A total of 502 patients met the inclusion criteria; 50% were preoperatively diagnosed with symptomatic cholelithiasis, 47% with biliary dyskinesia, 2% with hyperkinetic gallbladder, and 1% with gallbladder polyp(s). The majority were female (78%) and Caucasian (80%). In total, 60% (n = 301) of patients received PPA, while 40% (n = 201) did not; 1.3% (n = 4) of those who received PPA developed SSI, compared with 5.5% (n = 11) of those who did not receive PPA (p = 0.01). Though PPA use was associated with a 77% reduction in the risk of SSI in multivariate analysis (p = 0.01), all SSIs were superficial. One child required readmission for intravenous antibiotics, while the remainder were treated with outpatient antibiotics. Gender, age, body mass index, ethnicity, and preoperative diagnosis did not influence the likelihood of receiving PPA. Conclusion Given the relatively low morbidity of the superficial SSI, conservative use of PPA is advised to avoid contributing to antibiotic resistance.

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Frequency of port site infection following gall bladder removal through Epigastric vs Umbilical port.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.03.6309 ◽

2021 ◽

Vol 28 (03) ◽

pp. 277-281

Author(s):

Bushra Shaikh ◽

Imamuddin Baloch ◽

Azhar Ali Shah ◽

Abdul Sami Mirani ◽

Parkash Lal Lund ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Wound Infection ◽

Port Site ◽

Site Infection ◽

College Hospital ◽

Medical College ◽

Duration Of Surgery ◽

Group A ◽

Group B

Objective: To compare the frequency of port site wound infection following gall bladder removal through umbilical and epigastric port in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Surgical Unit 2, Ghulam Muhammad Mahar Medical College, hospital Sukkur. Period: 1st November 2019 to 30th October 2020. Material & Methods: All cases who underwent four port laparoscopic cholecystectomy were enrolled in two groups. All procedures were performed under general anesthesia. As the last event of surgery gall bladder was retrieved in a glove bag through umbilical port in group A and through epigastric port in group B, both under direct camera vision. Wound infection was considered if there was 3 to 5 grade of wound according to Southampton wound grading system (Figure-1) on 5th postoperative day. All demographics and outcome variables were recorded. Results: Age ranged from 20 to 60 years with mean age of 38.875±8.11 years, BMI 29.973±5.12 Kg/m2, duration of surgery 50.656±8.41 mins and Southampton score was 1.044±1.07 in Group A and mean age of 38.560±6.23 years, BMI 27.437±5.04 Kg/m2, duration of surgery 48.920±8.67 mins and Southampton score was 0.856±0.92 in Group B. In group A, 18 (5.7%)patients developed port site wound infection in contrast to 5 (1.6%) patients in group B (P= 0.006). Conclusion: We conclude that epigastric port retrieval of gall bladder following laparoscopic cholecystectomy results in less port site infection.

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