ARE PROPHYLACTIC ANTIBIOTICS REQUIRED FOR ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

BACKGROUND: Some clinicians administer prophylactic antibiotics routin ely before laparoscopic cholecystectomy, and the results of some of th e studies in the literature support this practice. We conducted a pros pective randomized trial to determine whether administration of prophy lactic antibiotics is necessary during routine laparoscopic cholecyste ctomy in low-risk patients. STUDY DESIGN: Two hundred fifty patients w ithout evidence of acute inflammation, common duct stones, or other in dications for antibiotics were randomized to receive three perioperati ve doses of cefazolin or no prophylaxis and followed up for complicati ons up to 30 days postoperatively. The primary end point was the occur rence of a major infectious complication, defined as that causing a sy stemic response, delaying discharge, or leading to readmission. Minor infectious problems were also noted, defined as those causing local sy mptoms only. RESULTS: One hundred twenty-eight patients were randomize d to receive prophylactic antibiotics (PA group), 122 to receive none (NONE group; two patients in this group were actually given preoperati ve antibiotics). Only one major complication occurred (in a patient in the NONE group), an abscess in the presence of a bile leak, despite t he 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 infectio n in a NONE patient and one urinary tract infection in a PA patient (n ot significant); all were easily managed. The prophlactic antibiotics did not sterilize the bile, and infectious complications were not asso ciated with weight, inflammation found at the time of operation, repor ted stone or bile spillage, or conversion to open operation. CONCLUSIO NS: Prophylactic antibiotics are not necessary for elective laparoscop ic cholecystectomy in low-risk patients.