ROLE OF PROPHYLACTIC ANTIBIOTICS IN LOW RISK ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY: IS THERE A NEED?
AbstractBackground: Elective cholecystectomy for symptomatic gall stone disease carries low risk of postoperative infective complications. Yet the routine use of prophylactic antibiotic is in vogue in many centres. The aim of this study was to find out the efficacy of antibiotic prophylaxis in preventing postoperative infective complications in low risk elective laparoscopic cholecystectomy patients. Method: Randomised controlled trial was carried out in our hospital from 1st Nov 2009 to 15th Oct 2011. A total of 350 patients were included in the study and were divided into Group A (n=177), and Group B (n=173). Group A was given single dose of injection Cefuroxime 1.5 gm as prophylactic antibiotic at the time of induction of anaesthesia, and Group B was not given any antibiotic. In both groups, age, sex, duration of surgery, American Society of Anesthesiologists classification, duration of surgery and length of hospital stay were recorded. Patients were followed-up weekly for 4 weeks and rates of superficial surgical site infections as well as intra-abdominal infections were recorded. Results: There were no significant differences in both groups in terms of age, sex, duration of surgery, length of hospital stay. Eight (4.5%) cases of superficial surgical site infection were noted in Group A and 7 (4.0%) in Group B which was insignificant statistically (p>0.05). Conclusion: In low risk patients antibiotic prophylaxis does not seem to affect the incidence of postoperative infective complications in elective laparoscopic cholecystectomy. The use of prophylactic antibiotics should be reserved for high risk patients undergoing laparoscopic cholecystectomy.Keywords: Antibiotic Prophylaxis, Cholecystectomy, Laparoscopy
McMahon AJ, Fischbacher CM, Frame SH, MacLeod MC. Impact of laparoscopic cholecystectomy: a population-based study. Lancet 2000;356:1632–7.
Shea JA, Berlin JA, Bachwich DR, Staroscik RN, Malet PF, McGuckin M, et al. Indications for and outcomes of cholecystectomy: a comparison of the pre and postlaparoscopic eras. Ann Surg 1998;227:343–50.
Cainzos M, Sayek I, Wacha H, Pulay I, Dominion L, Aeberhard PF, et al. Septic complication after biliary tract stone surgery: a review and report of the European prospective study. Hepatogastroenterology 1997;44:959–67.
A prospective analysis of 1518 laparoscopic cholecystectomies. Southern Surgeons Club. N Engl J Med 1992;324:1073–8.
Antibiotic prophylaxis in surgery: A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network; 2000.
Lippert H, Gastinger J. Antimicrobial prophylaxis in laparoscopic and conventional cholecystectomy. Chemotherapy 1998;44:355–63.
Harnoss BM, Hirner A, Dibbelt H, Haring R, Rodloff R, Lode H. Perioperative antibiotic prophylaxis in bile-duct interventions. Chemotherapy 1987;33:297–301.
Meijer WS, Schmitz PI, Jeekel J. Meta-analysis of randomized, controlled clinical trials of antibiotic prophylaxis in biliary tract surgery. Br J Surg 1990;77:283–90.
Wu CC, Yeh DC, Lin MC, Liu TJ, P'eng FK. Prospective randomized trial of systemic antibiotics in patients undergoing liver resection. Br J Surg 1998;85:489–93
Gondret R, Viallard ML, Huguier M. Antibiotic prophylaxis in biliary surgery. Ann Chir 1995;49:493–9. [Article in French]
Ulualp K, Condon RE. Antibiotic prophylaxis for scheduled operative procedures. Infect Dis Clin North Am 1992;6:613–25.
Berggren U, Gordh T, Grama D, Haglund U, Rastad J, Arvidsson D. Laparoscopic versus open cholecystectomy: hosptalization sick leave, analgesia, and trauma responses. Br J Surg 1994;81:1362–5.
Garcia N, Kapur S, McClane J, Davis JM. Surgical infections and prophylactic antibiotics: 341 consecutive cases of gallbladder surgery in the era of laparoscopic surgery. J Laparoendosc Adv Surg Tech A 1997;7:157–62.
Illig KA, Schmidt E, Cavanaugh J, Krusch D, Sax HC. Are prophylactic antibiotics required for elective laparoscopic cholecystectomy? J Am Coll Surg 1997;184:353–6.
Higgins A, London J, Charland S, Ratzer E, Clark J, Haun W, et al. Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary? Arch Surg 1999;134:611–4.
McGuckin, M, Shea, JA, Schwartz, JS. Infection and antimicrobial use in laparoscopic cholecystectomy. Infect Control Hosp Epidemiol 1999;20:624–6.
Tocchi A, Lepre L, Costa G, Liotta G, Mazzoni G, Maggiolini F. The need for prophylaxis in elective laparoscopic cholecystectomy: a prospective randomized study. Arch Surg 2000;135:67–70.
Frantzides CT, Sykes A. A reevaluation of antibiotic prophylaxis in laparoscopic cholecystectomy. J Laparoendosc Surg. 1994;4:375–8.
Thompson JE, Benninon RS, Doty JE, Muller EIL, Pitt HA. Predictive factors of bactibilia in acute cholecystitis. Arch Surg. 1990;125:261–4.
Landau O, Kott I, Deutsch AA, Stelman E, Reiss R. Multifactorial analysis of septic bile and septic complications in biliary surgery. World J Surg. 1992;16:962–5.
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