The absent role of prophylactic antibiotics in low-risk patients undergoing laparoscopic cholecystectomy. Role of prophylactic antibiotics in low risk elective laparoscopic cholecystectomy: is there a need? The Role of Prophylactic Antibiotics in Elective Laparoscopic Cholecystectomy Are prophylactic antibiotics required for elective laparoscopic cholecystectomy? Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Laparoscopic Cholecystectomy Without Prophylactic Antibiotics: A Prospective Study Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized trial. Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy. ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING? The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study. Are prophylactic antibiotics necessary in elective laparoscopic cholecystectomy, regardless of patient risk? Antibiotic Prophylaxis in Laparoscopic Cholecystectomy: A Randomized Controlled Trial Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary? A reevaluation of antibiotic prophylaxis in laparoscopic cholecystectomy: a randomized controlled trial. Role of prophylactic antibiotic in elective laparoscopic cholecystectomy. Determinants of postoperative infection after laparoscopic cholecystectomy. Infection after laparoscopic cholecystectomy: are antibiotics really necessary?
A retrospective chart review was done to determine the infection rate and the use of  prophylactic antibiotics  in consecutive laparoscopic cholecystectomies done in a single community .  Incisional infections were discovered in 11 of 566 cases , 10 of whom had received prophylactic antibiotics . The infected patients were significantly older , had longer procedures , and had more comorbidity than the uninfected patients . They were also more likely to have a palpable mass preoperatively and past biliary surgery . A second , prospect i ve study was done to evaluate the efficacy of the use of antibiotic prophylaxis in low-risk patients . Fifty-three patients were r and omized into two double-blinded groups . No incisional infections occurred in either group within 30 days postoperatively . This suggests prophylactic antibiotics are not needed to prevent infections for low-risk patients undergoing laparoscopic cholecystectomy BACKGROUND 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 R and omised 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 Celfuroxime 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 Background and Objectives : Elective laparoscopic cholecystectomy has a low risk for infectious complications , but many surgeons still use prophylactic antibiotics . The aim of this prospect i ve study was to investigate the necessity and test the efficacy of prophylactic antibiotics on postoperative infection complications in low-risk patients undergoing laparoscopic cholecystectomy . Methods : Low-risk patients were r and omly placed into 2 groups : 68 patients ( group 1 ) received cefazolin 1 g intravenously after induction of anesthesia , and 76 patients ( group 2 ) were not given prophylactic antibiotics . In both groups , septic complications were recorded and compared . Results : Positive bile culture and gallbladder rupture did not significantly increase the rate of surgical site infections . In group 1 , there were 3 ( 4.41 % ) cases of wound infection , 3 ( 4.41 % ) cases of pulmonary infections , and 1 ( 1.47 % ) case of urinary tract infection . In group 2 , there were 2 ( 2.63 % ) cases of wound infection , 2 ( 2.63 % ) case of pulmonary infections , and 3 ( 3.95 % ) cases of urinary tract infection . No significant difference existed in the complication rates . Conclusions : Based on our data , the use of prophylactic antibiotics does not decrease the rate of postoperative infection complications and surgical-site infections and is not necessary in low-risk patients undergoing laparoscopic cholecystectomy BACKGROUND Some clinicians administer prophylactic antibiotics routinely before laparoscopic cholecystectomy , and the results of some of the studies in the literature support this practice . We conducted a prospect i ve r and omized trial to determine whether administration of prophylactic antibiotics is necessary during routine laparoscopic cholecystectomy in low-risk patients . STUDY DESIGN Two hundred fifty patients without evidence of acute inflammation , common duct stones , or other indications for antibiotics were r and omized to receive three perioperative doses of cefazolin or no prophylaxis and followed up for complications up to 30 days postoperatively . The primary end point was the occurrence of a major infectious complication , defined as that causing a systemic response , delaying discharge , or leading to readmission . Minor infectious problems were also noted , defined as those causing local symptoms only . RESULTS One hundred twenty-eight patients were r and omized to receive prophylactic antibiotics  ( PA group ) , 122 to receive none  ( NONE group ; two patients in this group were actually given preoperative antibiotics ) . Only one major complication occurred ( in a patient in the NONE group ) , an abscess in the presence of a bile leak , despite the administration of antibiotics when the leak was discovered several days before infectious problems arose . There were four minor problems : two lower urinary tract infections and one superficial wound infection in a NONE patient and one urinary tract infection in a PA patient ( not significant ) ; all were easily managed . The prophylactic antibiotics did not sterilize the bile , and infectious complications were not associated with weight , inflammation found at the time of operation , reported stone or bile spill-age , or conversion to open operation . CONCLUSIONS Prophylactic antibiotics are not necessary for elective laparoscopic cholecystectomy in low-risk patients BACKGROUND 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 . METHODS The study included 100 patients undergoing laparoscopic cholecystectomy . They were r and omized 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 . RESULTS 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 . CONCLUSION A single dose of prophylactic antibiotic failed to decrease the likelihood of SSI after laparoscopic cholecystectomy Laparoscopic cholecystectomy has become the new gold st and ard 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 sub population 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 prospect i ve 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 1.5 years . Ages ranged from 11 to 70 years ( mean age of 33 years ) . 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 At present the use of prophylactic antibiotics in elective laparoscopic cholecystectomy is controversial . This prospect i ve study was carried out to define the role of prophylactic antibiotics in elective laparoscopic cholecystectomy to prevent postoperative infection .  Ninety three patients were r and omly placed in two groups . Group A comprised of 40 while group B consisted of 53 patients . Patients in Group A received 1.5 grams of second generation cephalosporin ( cefuroxime sodium ) diluted in 100ml of normal saline , at the time of induction of anesthesia . Group B patients received an equal volume of normal saline only . A sample of gall bladder bile was collected by direct gall bladder puncture intra-operatively for aerobic and anaerobic culture . Age , sex , weight of the patient , American Society of Anesthesiologists classification grade , presence of diabetes mellitus , episodes of colic 30 days preceding surgery , intra-operative gall bladder rupture , stone and / or bile spillage , results of bile culture , gall bladder histology , length of hospital stay , and number of septic complications were recorded and analyzed . In group A , one patient ( 2.5 % ) had post operative wound infection and in group B , two patients ( 3.8 % ) had post operative infection which was statistically similar ( p>0.1 ) . There was no difference between the two groups in terms of demographic , intra operative and post operative denominators . Therefore the study concluded that prophylactic antibiotics did not have a significant role to play in prevention of postoperative wound infection in elective laparoscopic cholecystectomy BACKGROUND Antibiotic prophylaxis is routinely administered in laparoscopic cholecystetomy but its role is debatable . METHODS From January 2004 to August 2008 , 417 patients were r and omized 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 ( 500 mg ) 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 5 mg 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 ABSTRACT Background : Elective laparoscopic cholecystectomy has very low risk for infectious complications , ranging the infection rate from 0.4 % to 1.1 % . Many surgeons still use routine antibiotic prophylaxis Aim : Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients . Method : Prospect i ve , r and omized and double-blind study . Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy  divided in two groups : group A ( n=50 ) , patients that received prophylaxis using intravenous Cephazolin ( 2 g ) during anesthetic induction and group B ( n=50 ) , patients that did n't receive any antibiotic prophylaxis . The outcome evaluated were infeccious complications at surgical site . The patients were review ed seven and 30 days after surgery . Results : There was incidence of 2 % in infection complications in group A and 2 % in group B. There was no statistical significant difference of infectious complications ( p=0,05 ) between the groups . The groups were homogeneous and comparable . Conclusion : The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients does n't provide any significant benefit in the decrease of surgical wound infection BACKGROUND The aim of this prospect i ve r and omized study was to investigate the necessity and impact of prophylactic antibiotics on postoperative infection complications in elective laparoscopic cholecystectomy . METHODS At the time of induction of anesthesia , group A patients ( n = 141 ) received 1 g cefazolin , and group B patients ( control ; n = 136 ) received 10 mL isotonic sodium chloride solution . Patients ' characteristics and general operative outcomes were compared and analyzed . RESULTS The overall rate of infection was 1.1 % for total 277 patients ( 0.7 % for group A patients and 1.5 % for group B patients ) . No significant difference in infection complications was found between these 2 groups . Also any risk factors contributing to infection complications could not be found . CONCLUSIONS We do not recommend the use of prophylactic antibiotics in elective laparoscopic cholecystectomy because they will not decrease the already-low rate of postoperative infectious complications Purpose The average rate of surgical site infections ( SSIs ) for laparoscopic cholecystectomy ( LC ) has been reported in the literature to be between 0.4 % and 6.3 % . Also , these recent review s have concluded that a prophylactic antibiotics for elective LCs in low-risk patients is not useful , but there were no results in high-risk patients . Methods The aim of this study was to investigate the role of a single dose of first-generation cephalosporin as a prophylactic antibiotic for patients undergoing elective LC , regardless of patient risk . This r and omized clinical trial was conducted from October 2013 to December 2014 by single surgeon at our hospital . Patients were r and omized into two groups by following method . Odd-numbered patients ( group A ) received 1-g cefazolin intravenously within 30 minutes before incision , whereas even-numbered patients ( group B ) received normal saline intravenously instead of prophylactic antibiotics , with the aim of including 100 patients in each group .  SSIs were recorded and compared between the groups . Results There were no differences in preoperative demographics and postoperative findings between the groups . There were no superficial and deep SSIs in either group , 9 cases of superficial seromas developed ( 4.5 % ) in the cohort : 4 in group A ( 4 % ) and 5 in group B ( 5 % ) . There were no significant associations between SSIs and the use of prophylactic antibiotics in either group . Additionally , the high-risk group did not show a significantly increased rate of SSIs . Conclusion Based on our study , prophylactic antibiotics are not necessary in elective LC , regardless of patient risk Background Recent meta-analyses concluded that antibiotic prophylaxis is not warranted in low-risk laparoscopic cholecystectomy . However , most trials in the meta-analyses had a relatively small sample size and were statistically underpowered . In addition , many of the trials mentioned potential cost savings owing to the elimination of prophylactic antibiotics . However , no trial has statistically estimated the cost effectiveness . To evaluate the results of meta-analyses , we conducted a r and omized controlled trial on the role of prophylactic antibiotics in low-risk laparoscopic cholecystectomy with an adequate sample size . Methods From March 2007 to May 2013 , at the Department of Surgery , Kansai Medical University , patients who were scheduled for elective laparoscopic cholecystectomy were r and omly assigned to one of two arms : those who were and were not administered prophylactic antibiotics . The primary endpoint was the occurrence of postoperative infections and secondary endpoints were postoperative hospital stay and medical costs . Findings During the study period , 518 patients were assigned to the Antibiotics group and 519 to the No antibiotics group . Occurrences of surgical site infections , distant infections and overall infections were significantly lower in the Antibiotics group than in the No antibiotics group ( 0.8 vs. 3.7 % , p = 0.001 , OR : 0.205 ( 95%CI : 0.069 to 0.606 ) ; 0.4 vs. 3.1 % , p = 0.0004 , OR : 0.122 ( 95%CI : 0.028 to 0.533 ) ; 1.2 vs. 6.7 % ; p<0.0001 , OR : 0.162 ( 95%CI : 0.068 to 0.389 ) , respectively ) . The postoperative hospital stay was significantly shorter in the Antibiotics group ( mean , SD : 3.69±1.56 vs. 4.07±3.00 ; p = 0.01 ) and the postoperative medical costs were significantly lower in the Antibiotics group ( mean , SD : $ 766±341 vs. 832±670 ; p = 0.047 ) . Multivariable analysis showed that independent risk factors for postoperative infectious complications were no prophylactic antibiotics ( p<0.0001 ) and age 65 or older ( p = 0.006 ) . Conclusions Perioperative administration of prophylactic antibiotics should be recommended in laparoscopic cholecystectomy to prevent postoperative infectious complications and to reduce medical costs . Trial Registration UMIN Clinical Trials Registry UMIN000003749 HYPOTHESIS Prophylactic antibiotic treatment in elective laparoscopic cholecystectomy does not lower the already low infection rate associated with this procedure . DESIGN AND SETTING Prospect i ve double-blind r and omized trial at a community-based training hospital . PATIENTS Four hundred fifty patients undergoing elective laparoscopic cholecystectomy were r and omized into 1 of 3 treatment arms : ( 1 ) preoperative cefotetan disodium , 1 g intravenously ; ( 2 ) preoperative cefazolin , 1 g intravenously ; and ( 3 ) intravenous placebo . There were no demographic differences between groups in age , smoking history , American Society of Anesthesiologists score , infection risk class , time of antibiotic administration prior to surgery , and type of skin preparation . INTERVENTIONS Laparoscopic cholecystectomy was attempted in all cases ; however , 10 patients required conversion to an open cholecystectomy and they were included in the statistical analysis . Preoperatively , all patients were r and omized in a blinded manner and received cefotetan , cefazolin , or placebo intravenously . RESULTS There were 10 postoperative infections . In the cefotetan group , there were 3 cases of superficial surgical site infections . In the cefazolin group , there were 2 superficial surgical site infections-1 pneumonia and 1 rhinosinusitis . In the placebo group , there were 2 superficial surgical site infections and 1 urinary tract infection . The overall infection rate in this series was 2.4 % . Follow-up was performed at routine postoperative visits and by telephone contact . Data were evaluated using the chi2 test and analysis of variance with Duncan post hoc test ( P<.05 ) . CONCLUSION Based on our data , use of prophylactic antibiotics does not decrease the rate of wound infections in elective laparoscopic cholecystectomy BACKGROUND To assess the result of antibiotic prophylaxis in low-risk patients undergoing elective laparoscopic cholecystectomy with respect to the postoperative septic complications . METHOD One hundred and two low-risk patients were r and omized into 1 of 2 treatment arms ( 1 ) cefazolin 1 g intravenously after induction of anesthesia ( PA group ) and ( 2 ) no prophylactic antibiotics ( NONE group ) . Laparoscopic cholecystectomy was attempted in all cases . The patients were followed-up for postoperative septic complications for at least 30 days at the out-patient clinic or by telephone contact . In both groups , sex , age , weight , American Society of Anesthesiologists patient classification score , operative time , surgical techniques , number of port sites , intraoperative cholangiograms , intraoperative gallbladder rupture , postoperative hospital stay , and postoperative septic complications were compared . The statistical analysis of data performed by computer program SPSS 10.0 for Windows was based on the Independent- Sample s T Test or the Pearson Chi-Square ( 2-sided ) . RESULTS There was only one minor problem of superficial wound infection in the NONE group . Comparison of data showed no statistically significant difference between the groups . CONCLUSION Antibiotic Prophylaxis may not be necessary in low-risk patients undergoing elective laparoscopic cholecystectomy This prospect i ve study was conducted to investigate the efficacy of single-dose Ceftazidime as a prophylactic antibiotic to prevent surgical site infections in low-risk patients undergoing LC . Two hundred patients included in the study were r and omly divided into two groups ( 100 each ) : G1 : patients received intravenous Ceftazidime within 60 minutes prior to surgery and G2 : received intravenous placebo ( 10 ml isotonic sodium chloride 0.9 % solution ) . All patients were invited for examination 10 , 20 and 30 days post-operatively and any post-operative complications were recorded and managed . Preoperatively ; there was no significant differences existed between the 2 groups regarding sex , age ; body mass index and ASA score . Also , the duration of LC surgery , incidence of intra-operative gallbladder perforations and spill of bile or stones , incidents of intra-operative bleeding from either cystic artery or gall bladder liver bed and mean postoperative hospital stay were found not significantly different between the 2 groups . Post operatively there was no statistical difference regarding the surgical site infection between the two groups BACKGROUND / AIMS The aim of this study was to evaluate the effect of antibiotic prophylaxis on the development of infectious complications in laparoscopic cholecystectomy . METHODOLOGY A total of 208 patients undergoing elective laparoscopic cholecystectomy were r and omized , double-blinded into one of two treatment arms : 1 ) cefazolin 1 g intravenously after induction of anesthesia and 2 ) no prophylactic antibiotics . The patients were followed-up for infectious complications for 30 days at the out-patient clinic . The data collected included age , sex , body mass index , ultrasonography findings , accompanying diseases , perforation during surgery , stone spillage , operation time , port of gallbladder delivery , suture material used for skin closure , preoperative and length of postoperative hospitalization , bile culture , pathology of the gallbladder , serum biochemical findings including alanine aminotransferase , aspartate aminotransferase , gammaglutamyl transpeptidase , bilirubin , alkaline phosphatase and glucose . RESULTS Overall rate of infection was 3.36 % . Four out of 105 patients who received antibiotics and 3 out of 103 patients who did not receive antibiotics developed infection . The difference was not statistically significant . Obesity and closing the skin with nylon sutures were found to be associated with increased rate of infectious complications . CONCLUSIONS Cefazolin prophylaxis in low risk patients has no effect on postoperative infection rate in laparoscopic cholecystectomy OBJECTIVE To establish the incidence of infection after laparoscopic cholecystectomy , and assess the need for antibiotic prophylaxis . DESIGN Prospect i ve open study . SETTING University teaching hospital , United Kingdom . SUBJECTS 253 consecutive patients undergoing laparoscopic cholecystectomy between September 1990 and January 1993 . INTERVENTIONS A single intravenous dose of cefuroxime 1.5 g at induction of general anaesthesia . MAIN OUTCOME MEASURES Infective complications . RESULTS Patients were review ed at two weeks and 12 months . At two weeks there had been two wound infections ( one resolved spontaneously and the other required removal of a gallstone from the subcutaneous tissue ) , two chest infections ( treated with antibiotics orally and physiotherapy ) , and one subhepatic abscess ( drained percutaneously under ultrasonographic control ) . No other complications were reported at 12 months . CONCLUSIONS Routine antibiotic prophylaxis may be unnecessary during elective laparoscopic cholecystectomy , but a r and omised controlled trial is necessary to confirm this
Conclusions The use of prophylactic antibiotics is effective for reducing the incidence of SSI and superficial SSI but is not effective for preventing deep SSI in low-risk patients who underwent elective laparoscopic cholecystectomy
Background s/ Aims The role of prophylactic antibiotics for laparoscopic cholecystectomy in low-risk patients is still unclear .
This study aim ed to verify the conclusion of previous meta-analyses concerning the effectiveness of antibiotic prophylaxis for elective laparoscopic cholecystectomy in low-risk patients .