Ann Hepatobiliary Pancreat Surg.  2018 Aug;22(3):231-247. 10.14701/ahbps.2018.22.3.231.

Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis

• Kim SH
• Yu HC
• Yang JD
• Ahn SW
• Hwang HP

• KMID: 2420612
• DOI: http://doi.org/10.14701/ahbps.2018.22.3.231

Abstract

BACKGROUNDS/AIMS
The role of prophylactic antibiotics for laparoscopic cholecystectomy in low-risk patients is still unclear. This study aimed to verify the conclusion of previous meta-analyses concerning the effectiveness of antibiotic prophylaxis for elective laparoscopic cholecystectomy in low-risk patients.
METHODS
Comprehensive literature searches were performed on electric databases and manual searches. Randomized controlled trials (RCTs), prospective studies, and retrospective studies comparing antibiotic prophylaxis to placebo or no antibiotics in low-risk elective laparoscopic cholecystectomy were included.
RESULTS
This study included 28 RCTs, three prospective studies, and three retrospective studies. In RCTs, prophylactic antibiotics did not prevent deep surgical site infections (SSI) (RR 1.10, 95% confidence interval [CI] [0.45-2.69], p=0.84) but reduced SSI (RR 0.70, 95% CI [0.53-0.94], p=0.02), and superficial SSI (RR 0.58, 95% CI [0.42-0.82], p=0.01). Prospective studies showed prophylactic antibiotics did not reduce superficial SSI (RR 0.35, 95% CI [0.01-8.40], p=0.52) but reduced SSI (RR 0.12, 95% CI [0.04-0.35], p=0.0001). In retrospective studies, antibiotic prophylaxis did not reduce SSI (RR 1.59, 95% CI [0.30-8.32], p=0.58). The pooled data (12121 patients) including RCTs and prospective and retrospective studies showed that prophylactic antibiotics were not effective in preventing deep SSI (RR 1.01 95% CI [0.46-2.21], p=0.98) but effective in reducing SSI (RR 0.67, 95% CI [0.51-0.88], p=0.003) and superficial SSI (RR 0.61, 95% CI [0.45-0.83], p=0.002).
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.

Keyword

Laparoscopic cholecystectomy; Antibiotic prophylaxis; Meta-analysis

MeSH Terms

Anti-Bacterial Agents*
Antibiotic Prophylaxis
Cholecystectomy, Laparoscopic*
Humans
Incidence
Prospective Studies
Retrospective Studies
Surgical Wound Infection
Anti-Bacterial Agents

Figure

• 

  Fig. 1 PRISMA flow diagram for study search.

• 

  Fig. 2 Forest plot for surgical site infections in low-risk patients undergoing elective laparoscopic cholecystectomy. A Mantel-Haenszel fixed-effect model was for used for meta-analysis. Risk ratios are shown 95% confidence intervals.

• 

  Fig. 3 Forest plot for superficial surgical site infections in low-risk patients undergoing elective laparoscopic cholecystectomy. A Mantel-Haenszel fixed-effect model was for used for meta-analysis. Risk ratios are shown 95% confidence intervals.

• 

  Fig. 4 Forest plot for deep surgical site infections in low-risk patients undergoing elective laparoscopic cholecystectomy. A Mantel-Haenszel fixed-effect model was for used for meta-analysis. Risk ratios are shown 95% confidence intervals.

• 

  Fig. 5 Funnel plot for determination of publication bias in the subgroup analysis of SSI from all included studies. RR, Risk ratio; SE, Standard error.

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