Antibiotics In Laparoscopic Cholecystectomy Research Articles

Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta-analysis

Whether perioperative administration is required in elective laparoscopic cholecystectomy (LC) in patients with low risk of infection remains controversial. To investigate whether perioperative use of prophylactic antibiotics during elective LC can reduce the incidence of postoperative infection using a meta-analysis. Pubmed, Cochrane Library, Embase, and reference lists were searched up to October 26, 2020, for randomized controlled trials (RCTs) of the perioperative use of antibiotics during LC. A systematic review with meta-analysis, meta-regression, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) of the evidence was conducted. The Cochrane (RoB 2.0) tool was used to assess the risk of bias. A total of 14 RCTs were ultimately included in the meta-analysis, involving a total of 4360 patients. The incidence of surgical site infections, distant infections, and overall infections was investigated and the relationship with the perioperative use of prophylactic antibiotics during LC analyzed. The results indicated that in low-risk patients undergoing elective LC, prophylactic antibiotics reduce the incidence of surgical site infections (RR 0.66; 95% CI 0.45-0.98), with a moderate GRADE of evidence, distant infections (RR 0.34; 95% CI 0.16-0.73), with a low GRADE of evidence and overall infections (RR 0.57; 95% CI 0.40-0.80), with a moderate GRADE of evidence. The present meta-analysis demonstrates that the perioperative use of antibiotics in LC is effective in low-risk patients, possibly reducing the incidence of surgical site infections, distant infections, and overall infections. However, in view of the limitations of the study, it is recommended that studies with a more rigorous design (for downgraded factors) and larger sample size should be conducted in the future so that the conclusions above can be further verified through key result indicators.

STEP TOWARDS PREVENTION OF ANTIBIOTIC RESISTANCE – A PROSPECTIVE STUDY IN LAPAROSCOPIC CHOLECYSTECTOMY.

Introduction: Traditionally antibiotics have been advised pre and post operatively in surgery for gall bladder. The knowledge about usage of a single dose prophylactic preoperative antibiotic in comparison to conventional usage of perioperative antibiotics in laparoscopic Cholecystectomy is limited. Hence, this study focuses on comparing the efficacy of a single dose prophylactic antibiotic versus the usage of pre and postoperative antibiotics in laparoscopic Cholecystectomy.
 Method: This is a prospective study conducted in the General Surgery department of Apollo Institute of Medical Sciences and Research. Over 192 consecutive patients subjected for laparoscopic Cholecystectomy were included in study. They were divided in two groups (A&B) after applying exclusion. 74 patients in group A were given single dose of preoperative prophylactic antibiotic. No further post-operative antibiotics were given. 78 patients in group B were given both pre and postoperative antibiotics. Infective complications and cost constraints were compared between both the groups. Statistical analysis was done using chi-square test wherever necessary.
 Results: there is no significant difference in the rate of incidence of wound infection in both the groups. Age and gender had no significant association for SSI. The overall cost of Group B was found to be significantly higher than Group A.
 Conclusion: Usage of single dose prophylactic preoperative antibiotics with no further post operative antibiotics would be sufficient to prevent surgical site infection in uncomplicated laparoscopic Cholecystectomy.
 Keywords: Prevention, Antibiotic Resistance, Laparoscopic Cholecystectomy.

A prospective study: role of prophylactic antibiotics versus no antibiotics in elective laparoscopic cholecystectomy

Background: Elective gallbladder surgery is the most common abdominal surgical procedure. Antibiotic prophylaxis is a common conduct in open cholecystectomy, but there is ambiguity about the use of prophylactic antibiotics in laparoscopic cholecystectomy. Some surgeons suggest that the elimination of prophylactic antibiotics in patients undergoing elective laparoscopic cholecystectomy increase the incidence of postoperative infective complications but not to a statistically significant degree. The aim of this study was to evaluate the role of prophylactic antibiotics in laparoscopic cholecystectomy.Methods: A total of 100 patients were included and they were randomized in 2 groups of 50 each. Group A was given prophylactic intravenously (IV) antibiotic within 1 hour before surgery and group B was not given any antibiotics. Results were compared and data analyzed statistically using chi-square and t test. Complications in both the groups were compared.Results: Rate of surgical site infections were 6% (n=3) and 4% (n=2) in group A and B respectively; and the difference between them was not found statistically significant. All infections which occurred in present study were superficial surgical site infection. There was no evidence of deep-seated infections and none of the patients developed distant infection. There was no derangement in any of the biochemical parameter in this study.Conclusions: We were not able to demonstrate any significant benefit from addition of prophylactic antibiotics in elective laparoscopic cholecystectomy.

The Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy

The inappropriate or excess use of antibiotics is one of the biggest current threats to global health and there is therefore a drive to minimse antibiotic use including for prophylaxis. Perioperative antimicrobial prophylaxis is administered prior to surgical procedures to prevent surgical site infections.

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

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.

Evaluation of role of prophylactic antibiotics in laparoscopic cholecystectomy - a prospective randomized study

Evaluation of role of prophylactic antibiotics in laparoscopic cholecystectomy - a prospective randomized study

Laparoscopic Cholecystectomy Without Prophylactic Antibiotics: A Prospective Study

Laparoscopic cholecystectomy has become the new gold standard for management of symptomatic gallstones. Prophylactic antibiotics are used in elective surgery by the majority of surgeons, and their role in biliary tract surgery has been well established for a subpopulation of high-risk patients. This consensus has been derived from multiple studies involving biliary tract surgery before and in the era of laparoscopic cholecystectomy. But the use of prophylactic antibiotics in laparoscopic cholecystectomy especially in the low-risk group is now controversial and varied among the surgeons all over the world. To study the role of prophylactic antibiotics in laparoscopic cholecystectomy in different risk groups of patients, a prospective study was conducted in the Department of Surgery of Bankura Sammilani Medical College and Hospital from January 2010 to July 2011. All patients with symptomatic gallstones who underwent elective laparoscopic cholecystectomy during this period are included in this study. One hundred and two patients with symptomatic gallstones were operated on by laparoscopic technique without receiving preoperative antibiotics and studied over a period of 1.5years. Ages ranged from 11 to 70years (mean age of 33years). There were 14 males (13.72% of the patients) and 88 females (86.27% of the patients). There was no wound infection (class I) in 99 patients, and class II type of wound infection, i.e., surgical site infection, occurred in three patients (i.e., 2.94%) out of a total of 102 patients. Swabs were taken for culture and sensitivity; Staphylococcus aureus was found in two patients and Streptococcus viridans in one patient. In all three patients, infection occurred at the umbilical port sites, detected on the 3rd and 4th postoperative days. Antibiotic prophylaxis is not necessary in low-risk patients with symptomatic gallstone disease undergoing elective laparoscopic cholecystectomy to prevent postoperative infection-related complications. Preoperative skin preparation with chlorhexidine gluconate scrub may replace the use of prophylactic antibiotics for prevention of infection-related complications in patients undergoing elective laparoscopic cholecystectomy.

The Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy in Preventing Postoperative Infection: A Meta-Analysis

Although laparoscopic cholecystectomy (LC) is a common and widely applied technique, the use of antibiotics during the perioperative period in infection prevention remains controversial. In our study, a meta-analysis was performed to assess the impact of antibiotic prophylaxis on the postoperative infection rate in LC. A literature search was conducted on studies published between January 1966 and March 2010 that involved LC and prophylactic administration of antibiotics. Only randomized trials that compared perioperative antibiotic prophylaxis with placebo or no treatment in low-risk patients undergoing LC were selected. Eighteen studies qualified according to the inclusion criteria, but only 12 were of adequate quality according to the Jadad scale to be included for the meta-analysis. Data were analyzed via the Peto odds ratio (OR) method and run using RevMan 4.2 software. The precision of the estimation of OR by individual studies was used to calculate their contribution (or weighting) to the pooled OR. The results of the 12 studies did not have significant heterogeneity, and thus, the fixed effect model was used for data analysis. Compared with placebo or no treatment, there was no significant risk reduction in the antibiotic prophylaxis group with regard to overall infections (OR=1.11; 95% confidence interval [CI], 0.68-1.82; P=.67), wound infections (OR=1.07; 95% CI, 0.59-1.94; P=.99), major infections (OR=2.88; 95% CI, 0.3-28.09; P=.36), distant infections (OR=1.01; 95% CI, 0.43-2.36; P=.99), or positive bile cultures (OR=0.76; 95% CI, 0.54-1.08; P=.12). However, prophylactic antibiotics did shorten length of hospital stay (weighted mean difference=-0.16; 95% CI, -0.22 to -0.09; P<.01). Prophylactic antibiotics are not necessary for elective LC in low-risk patients.

Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy and Risk Factors for Surgical Site Infection: A Randomized Controlled Trial

The aim of this clinical trial was to determine whether prophylactic antibiotics could prevent surgical site infection (SSI) after laparoscopic cholecystectomy and to identify any risk factors for infection. The study included 100 patients undergoing laparoscopic cholecystectomy. They were randomized to receive either a single dose of ceftriaxone (Group A; n = 50) or physiologic saline as placebo (Group B; n = 50) after the induction of anesthesia. Patient demographics and clinical and surgical outcomes were recorded. The incidence of SSI was similar in the two groups: 2 patients in group A and 4 patients in group B (chi(2) = 0.71; p = 0.40). None of the factors studied was associated with surgical site infection statistically, as shown by binary logistic regression analysis. A single dose of prophylactic antibiotic failed to decrease the likelihood of SSI after laparoscopic cholecystectomy.

Role of prophylactic antibiotics in laparoscopic cholecystectomy

Background: Antibiotic prophylaxis is routinely administered in laparoscopic cholecystectomy but its role is debatable. Methods: From January 2004 to August 2008, 417 patients were randomized into 208 in antibiotic group (AG) and 209 in non antibiotic group (NAG). AG received one dose each of injection ciprofloxacin (200 mg) and metronidazole (500mg) preoperatively. NAG was given only intravenous fluids. Besides routine care, all underwent abdominal sonography and liver function tests at least once during the 30 postoperative days. Result: Age, sex and co-morbidity distribution were similar in both the groups. One patient who was on weekly 5mg methotraxate (NAG) had erythema around umbilical port. Other three having umbilical discharge recovered without antibiotics. Nine patients had subhepatic collection (5 AG and 4 NAG). One from NAG underwent re-laparoscopy and drainage. Ten patients had fever. Two from AG had basal lung collapse and were given antibiotics. Conclusion: Antibiotic prophylaxis is not needed for laparoscopic cholecystectomy.

Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy: A Meta-Analysis

BackgroundThe role of prophylactic antibiotics in laparoscopic cholecystectomy in low-risk patients is controversial. We conducted a meta-analysis to evaluate the efficacy of prophylactic antibiotics in low-risk patients (those without cholelithiasis or cholangitis) undergoing laparoscopic cholecystectomy. MethodsMultiple databases and abstracts were searched. Randomized controlled trials (RCTs) comparing prophylactic antibiotics to placebo or no antibiotics in low-risk laparoscopic cholecystectomy were included. The effects of prophylactic antibiotics were analyzed by calculating pooled estimates of overall infections, superficial wound infections, major infections, distant infections, and length of hospital stay. Separate analyses were performed for each outcome by using odds ratio or weighted mean difference. Both random and fixed effects models were used. Publication bias was assessed by funnel plot. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency. ResultsNine RCTs (N = 1,437) met the inclusion criteria. No statistically significant reduction was noted for those receiving prophylactic antibiotics and those who did not for overall infectious complications (p = 0.20), superficial wound infections (p = 0.36), major infections (p = 0.97), distant infections (p = 0.28), or length of hospital stay (p = 0.77). No statistically significant publication bias or heterogeneity were noted. ConclusionsProphylactic antibiotics do not prevent infections in low-risk patients undergoing laparoscopic cholecystectomy.

Clostridial Gas Gangrene of the Abdominal Wall After Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is associated with a considerable rate of infectious complications of up to 2.8%. Such infections are usually of minor clinical importance. However, we observed a case of life-threatening Clostridial gas gangrene centering around the right lateral port site and developing across all of the right-sided abdominal wall, causing septic shock and severe multi-organ failure. Considering the overall infection rate and the possibility of even severe morbidity, we advocate perioperative antibiotics in laparoscopic cholecystectomy.