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

Abstract

Premise and Objective:Elective laparoscopic cholecystectomy (LC) has low risk for post-operative infectious complications; still most clinicians use persistent post-operative prophylactic antibiotics out of habit, tradition, or simply as defensive practice due to evolving medicolegal implications of a large number of surgeries being showcased as daycare or next day discharge procedures. This randomised prospective trial was done to test the need for such prophylaxis in cases of elective LC in a rural/semi-urban setting.Materials and Methods:Two hundred and ten successive patients undergoing elective LC were randomised into groups receiving single dose of injection ceftriaxone at the time of induction of anaesthesia, (Group A = 112 cases) and those who in addition to above received injection ceftriaxone twice daily for 2 days postoperatively (Group B = 98 cases). Post-operative infectious complications between two groups were compared for variables such as age, sex, body mass index and bile/stone spillage.Results:There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, American Society of Anesthesiologists grade, duration of surgery and hospital stay. Intraoperative spillage of stones (9.8% [A]: 5.1% [B]) did not increase infectious complications even in the presence of positive bile culture (Group A, N = 7 vs. Group B, N = 3). An operative time of greater than 60 min was found to be associated with increased surgical site infection (P = 0. 0006).Conclusion:Single dose of ceftriaxone at the time of induction is adequate prophylaxis following elective LC even in the rural/semi-urban Indian setting and routine continued administration of antibiotic should be abandoned as it contributes to adverse reactions, drug resistance and unnecessary financial burden.

Step Towards Prevention of Antibiotic Resistance – A Prospective Study in Laparoscopic Cholecystectomy.

“…The rate of wound infection in case of Cholecystectomy lies between 1.1% to 5.4%. 2,3 The incidence of wound infection is even lower when the laparoscopic procedure is performed compared to an open surgical procedure. 10,11 This is because laparoscopy is a clean surgery with minimal handling of the surgical site.…”

“…The incidence of wound infection is even lesser when laparoscopic cholecystectomy is performed. 2,3 Prophylactic antibiotics are recommended in laparoscopic cholecystectomy. 4,5 Some studies reported that post-operative antibiotics may not be required in cases of uncomplicated cholecystectomies.…”

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

“…1 Symptomatic cholelithiasis is a disease of females (Female>Male) and the gender frequency in the study (83.3% -female, 16.6% -male) is similar to previous studies. 2,4,[6][7][8][9]14 The incidence of PSI in single dose LC is 0-4% and 0-7% in multiple doses LC. [14][15][16][17][18] Though there was no PSI in the study but considering the level 1 evidence we would recommend single preoperative dose of antibiotic in LC.…”

“…[1][2][3] On the other hand it is also true that despite improved sterilization techniques and other laparoscopic surgical technical reforms PSI still exists. [1][2][3]4 Social taboo, lack of confidence in part of the surgeon and other industry driven facts, which are beyond the scope of this discussion, are reasons behind such inappropriate and irrational use of postoperative multiple dose antibiotics. It has been proved beyond doubt that a single preoperative dose of antibiotic is sufficient to prevent SSI in LC.…”

“…It has been proved beyond doubt that a single preoperative dose of antibiotic is sufficient to prevent SSI in LC. [1][2][3][4] The need of the hour is to understand the fact that PSI is a totally different subset of infection and antibiotics are not a solution to this problem. The core issue of "prevention" is the principal solution.…”