Antibiotic prophylaxis is necessary for elective laparoscopic cholecystectomy ?

Pinnara Manokit-udom, Dr, Panot Yimcharoen, Dr, Setthasiri Pantanakul, Dr, Poschong Suesat, Dr, Petch Kasetsuwan, Dr. Bhumibol Adulyadej Hospital

Background: Although laparoscopic cholecystectomy (LC) has low rate of wound infection, the prophylactic antibiotic has been routinely used for prevent infection. The aim of this study was to compare surgical site infection rate between the patients who received and who did not receive prophylactic antibiotic in elective LC.

Materials and methods: From May 2014 to July 2015, there were 169 patients underwent elective laparoscopic cholecystectomy (LC) in our institute. The patients with symptomatic gallstones and ASA class 1- 2 were included into this study. Patients who had history previous hepatobiliary tract infection (cholecystitis, chloangitis) and/or biliary endoscopic intervention within 3 months before LC were excluded. Demographic data, indication for surgery, type of antibiotic, intra-operative bile spillage, bile culture and post-operative wound infection were recorded.  Patients were divided into 2 groups; group A: the patients who underwent LC with third generation of cephalosporin antibiotic prophylaxis and group B : the patients who underwent LC without prophylactic antibiotics. Bile culture from gallbladder was taken in all cases. The wound was observed and followed up within a month.

Results: Forty-eight patients were randomized and included into this study. In group A, there were 24 patients ( 7 M, 17 F ), mean age 59.1 ± 13.2 years (34-86). In group B, there were 24 patients ( 10 M, 14 F ), mean age 58.7 ± 15.2 years (26-79). During surgery, we had 7 cases of accidental ruptured gallbladder in group A and 2 cases in group B. The post operative wound infection developed in 1 case of group B (4.2%) and no patient developed wound infection in group A (0%). The overall, 13 patients (7 in group A and 6 in group B) had positive bile cultures (27%). The commonest pathogen was Escherichia coli (6 in 13 patients, 46.2% of positive culture).

Conclusions: There was no statistical significant difference in surgical site infection between both groups ( p = 0.32). This study has small sample size, however better study design with more population is in the process of recording and reviewing.

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