Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections

Abstract

Surgical site infection is rare after LC, and antibiotic prophylaxis does not appear to affect the outcome significantly. Moreover, factors such as positive bile cultures, history of biliary attack, ASA score, diabetes, obesity, and smoking do not have any effect on SSI development. Thus, we conclude that antibiotic prophylaxis is not needed for elective LC.

Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis

“…In RCTs, only 12 studies212228323638404243444547 showed the data from intention-to-treat analysis, and the other 16 studies20232425262729303133343537394146 showed data from per-protocol analysis.…”

“…Subgroup analysis for SSI including both superficial and deep SSI was performed using 28 RCTs,20212223242526272829303132333435363738394041424344454647 3 prospective studies,484950 and 3 retrospective studies 225152. In the 28 RCTs, 83 (2.07%) of the 4018 patients in the prophylactic antibiotic group developed SSI compared with 119 (3.17%) of the 3752 patients in the no prophylaxis group.…”

“…The Scottish Intercollegiate Guidelines Network1 also include diabetes, emergency surgery, long duration of procedures, ASA score of 3 or higher, recent episode of colic within 30 days before surgery and age >70 years as high-risk group for SSI. However, several studies232526272846 included patients with an ASA score of 3 or the ASA score was not applied to inclusion criteria in several RCTs 2232384043. Therefore, future studies need to provide a consistent set of inclusion criteria based on guidelines for defining low-risk or high-risk groups for SSI.…”

“…Jadad et al19 score was also applied to assess the quality of included randomized studies in the meta-analysis. Of the 28 RCTs,20212223242526272829303132333435363738394041424344454647 25 studies22232425262728293031323334353637394041424344454647 were eligible to be included in the meta-analysis with high-quality Jadad score ≥3, and the other 3 studies202138 were low-quality studies with Jadad score 2. Sensitivity tests were performed to assess whether including three RCTs classified as low-quality is appropriate in this meta-analysis.…”

Comprehensive Preventive Approach to Surgical Site Infections (SSIs): A Review

“…Dirty surgeries (25), surgeries on devitalized tissues, foreign bodies, contamination with feces, and perforated guts, are prone to infection (11), surgeries of contaminated areas (abdomen, perinea and lower limbs are usually more contaminated than the other sites) (21), emergent surgeries versus elective surgeries (1,11,16), extensive operation area, incomplete preparation of surgical area, inadequate duration of surgical scrub (2, 10), operation duration (risk of infection rises in the times more than 2 hours) (1, 2, 10, 16), incision length > 14.7 cm (26), surgery technique, simple or complex technique (1,10,21), open surgery versus laparoscopic methods (27,28), extensive and repeated cauterization (copious use of subcutaneous electrocautery) (11), poor oxygenation and poor homeostasis action of operation area (7), increase of bleeding and hematoma formation (29), use of drains, especially in the abdominal surgeries (25), insertion of foreign material or implants (2, 10), inadequate sterilization of surgical equipment (1, 2, 10).…”