Can post-operative antibiotic prophylaxis following elective laparoscopic cholecystectomy be completely done away with in the Indian setting? A prospective randomised study

Introduction Laparoscopic surgeons in Great Britain and Ireland were surveyed to assess their use of antibiotic prophylaxis in elective laparoscopic cholecystectomy. This followed a Cochrane review that found no evidence to support the use of antibiotic prophylaxis in routine cases. Methods Data were collected on routine use of antibiotics in elective laparoscopic cholecystectomy, and how that was influenced by factors such as bile spillage, patient co-morbidities and surgeons’ experience. An online questionnaire was sent to 450 laparoscopic surgeons in December 2011. Results Data were received from 111 surgeons (87 consultants) representing over 7,000 cases per year. In routine cases without bile spillage, 64% of respondents gave no antibiotics and 36% gave a single dose. In cases with bile spillage, 11% gave no antibiotics. However, 80% gave one dose and 7% gave three doses. Co-amoxiclav was used by 75% of surgeons. Surgeons are more likely to give antibiotics when patients have risk factors for infective endocarditis. Conclusions This study suggests over 20,000 doses of antibiotics and over £100,000 could be saved annually if surgeons modified their practice to follow current guidelines.

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ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING?

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600030010 ◽

2016 ◽

Vol 29 (3) ◽

pp. 170-172 ◽

Cited By ~ 5

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.

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The Need for Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy

Archives of Surgery ◽

10.1001/archsurg.135.1.67 ◽

2000 ◽

Vol 135 (1) ◽

pp. 67 ◽

Cited By ~ 58

Author(s):

Adriano Tocchi

Keyword(s):

Laparoscopic Cholecystectomy ◽

Antibiotic Prophylaxis ◽

Elective Laparoscopic Cholecystectomy

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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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