Antibiotic Prophylaxis in Laparoscopic Cholecystectomy: A Randomized Controlled Trial Role of prophylactic antibiotics in low risk elective laparoscopic cholecystectomy: is there a need? ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING? The Role of Prophylactic Antibiotics in Elective Laparoscopic Cholecystectomy Laparoscopic Cholecystectomy Without Prophylactic Antibiotics: A Prospective Study A reevaluation of antibiotic prophylaxis in laparoscopic cholecystectomy: a randomized controlled trial. The absent role of prophylactic antibiotics in low-risk patients undergoing laparoscopic cholecystectomy. Are prophylactic antibiotics required for elective laparoscopic cholecystectomy? Prevalence, pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir. Determinants of postoperative infection after laparoscopic cholecystectomy. The efficacy of cefazolin in reducing surgical site infection in laparoscopic cholecystectomy: a prospective randomized double-blind controlled trial The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study. The Effect of Prophylactic Antibiotics on Post Laparoscopic Cholecystectomy Infectious Complications: A Double-Blinded Clinical Trial Are prophylactic antibiotics necessary in elective laparoscopic cholecystectomy, regardless of patient risk? Routine use of antibiotic prophylaxis in low-risk laparoscopic cholecystectomy is unnecessary: a randomized clinical trial. A prospective, randomised trial of prophylactic antibiotics versus bag extraction in the prophylaxis of wound infection in laparoscopic cholecystectomy. Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary? Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized trial. Can post-operative antibiotic prophylaxis following elective laparoscopic cholecystectomy be completely done away with in the Indian setting? A prospective randomised study Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy. Infection after laparoscopic cholecystectomy: are antibiotics really necessary? The need for antibiotic prophylaxis in elective laparoscopic cholecystectomy: a prospective randomized study. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications. Surgical infections after laparoscopic cholecystectomy: ceftriaxone vs ceftazidime antibiotic prophylaxis. A prospective study. Effect of Cefazolin Prophylaxis on Postoperative Infectious Complications in Elective Laparoscopic Cholecystectomy: A Prospective Randomized Study Role of prophylactic antibiotic in elective laparoscopic cholecystectomy. Antimicrobial prophylaxis in laparoscopic and conventional cholecystectomy . Conclusions of a large prospective multicenter quality assurance study in Germany. Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Acute Cholecystitis: Early Versus Delayed Cholecystectomy, A Multicenter Randomized Trial (ACDC Study, NCT00447304) Antibiotic prophylaxis in elective cholecystectomy: a randomized, double blinded study comparing ciprofloxacin and cefuroxime. Routine Administration of Antibiotics to Patients Suffering Accidental Gallbladder Perforation During Laparoscopic Cholecystectomy is not Necessary Prophylactic antibiotics in open mesh repair of inguinal hernia - a randomized controlled trial. Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study Complications of daytime elective laparoscopic cholecystectomies performed by surgeons who operated the night before. Ondansetron versus metoclopramide in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy: a prospective double-blind randomized study. Does splanchnic ischemia occur during laparoscopic
cholecystectomy?
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 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 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 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 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 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 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 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 The aim of this study was to determine specific pattern of port site microbial colonisation , sensitivity and resistance to different antibiotics of bacteria isolated from port site infection ( PSI ) in low risk patients after elective laparoscopic cholecystectomy in surgical wards at tertiary care hospital of Kashmir . This is a prospect i ve study . The study included 675 consecutive patients of postoperative PSI after elective laparoscopic cholecystectomy for symptomatic cholelithiasis over a period of 12 months . Culture swabs were taken from port sites with signs of PSI and transported to the microbiology laboratory . The positive swab cultures were subjected to antibiotic susceptibility test . The data obtained was analysed by using appropriate statistical analytical tests . The incidence of PSI after elective laparoscopic cholecystectomy is 6·7 % . The commonest organism responsible for PSI is pseudomonas , 19 ( 42·2 % ) cases . Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital , pseudomonas was found 100 % resistant to the combination of ampicillin + sulbactum and ceftriaxone and it was sensitive to imipenem , amikacin and vancomycin in 89·47,57 and 52·63 % of cases respectively . Our study will be helpful in choosing effective empirical prophylactic antibiotic therapy in cases of elective laparoscopic cholecystectomy and will have a great impact on morbidity and mortality in them because of PSI 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 Background A prophylactic antibiotic is recommended in open cholecystectomy surgeries , but in laparoscopic cholecystectomies such prophylaxis is controversial . Recent review s have not found conclusive evidence that routine prophylaxis , especially in low risk patients , is effective . This clinical trial was undertaken to evaluate the efficacy of cefazolin in reducing surgical site infection SSI in laparoscopic cholecystectomies in a sample not screened for high or low risk patients . Methods A r and omized double-blind controlled trial was conducted in a single university hospital . Scheduled cholecystectomy patients without selection for patient risk factors were r and omized into two groups . Pre-operatively , group A patients received a placebo of 10 ml isotonic sodium chloride , and group B patients received 1 g of cefazolin as a prophylactic antibiotic . All patients underwent a st and ard laparoscopic cholecystectomy , and were followed up for at least 30 days . Results Two hundred ninety-nine patients were r and omized ( 149 in group A and 150 in group B ) .  SSI occurred in seven patients ( 2.34 % ) , five ( 1.67 % ) in the placebo group , and two ( 0.67 % ) in the prophylactic antibiotic group . The difference was not statistically significant ( p value = 0.512 ) , and no specific risk factors for post-operative infection were identified . Conclusions A single dose of preoperative prophylactic cefazolin has no significant benefit in reducing the incidence of SSI in laparoscopic cholecystectomy . Whether or not to use a prophylactic depends on the individual patient , and the consideration of the attending surgeon 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 Background Laparoscopic cholecystectomy ( LC ) is one of the most common surgeries in laparoscopic surgery . Although , it is believed that LC has low-risk for post-operative infectious complications , the use of a prophylactic antibiotic is still controversial in elective LC . Objective To determine the impact of prophylactic antibiotics on postoperative infection complications in elective laparoscopic cholecystectomy . Methods In this double-blind , placebo-controlled , r and omized , clinical trial , patients who were c and i date s for elective LC , from March 2012 to 2015 , in four hospitals in Babol , Iran , were studied . Patients were allocated r and omly to two groups , i.e. , group C : Cefazolin ( n = 182 ) and group P : placebo ( n = 247 ) . Group C received 1 g of Cefazolin 30 minutes before anesthesia and and then , six and 12 hours after anesthesia . Group P patients received 10 ml of isotonic sodium chloride solution . Age , gender , type of gallbladder diseases ( stone , polyp , or hydrops ) , the length of post-operative hospitalization , frequency of gallbladder rupture , the duration of surgery , and the kinds of complications associated with infections were collected for each patient in the two groups . The data were analyzed by IBM-SPSS version 20 , using the t-test and the chi-squared test , and a p-value < 0.05 was considered as significant . Results There were no significant differences between the two groups in terms of gender ( C versus P : 18 ( 9.9 % ) male versus 22 ( 9 % ) ; p = 0.74 ) , age ( C versus P : 43.75 + 13.30 years versus 40.91 + 13.05 ; p = 0.20 ) , and duration of surgery ( C versus P : 34.97 ± 8.25 min versus 34.11 ± 8.39 ; p = 0.71 ) . There were no significant differences between the two groups in the incidences of post-operative infection ( C versus P : 3 ( 1.7 % ) versus 5 ( 2 % ) ; p = 0.99 ) and rupture of the gallbladder ( C versus P : 14 ( 7.8 % ) versus 17 ( 6.8 % ) ; p = 0.85 ) . No other post-operative systemic infectious complications ( e.g. , sepsis , pneumonia , or urinary tract infection ) were found in either group . Conclusion For patients who underwent laparoscopic cholecystectomy ( LC ) , prophylactic antibiotics had no important role in the prevention of infections ; so these antibiotics apparently are not necessary in treatment , and they are not recommended for patients with laparoscopic cholecystectomy as low-risk selective antibiotics . Trial registration The trial was registered at the Iranian Clinical Trial Registry ( http://www.i rct .ir ) with the I RCT identification number I RCT 2013070413865N1 . Funding This research was supported financially by the Research Council of Babol University of Medical Sciences 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 Laparoscopic cholecystectomy uses smaller incision and trocars that lessen the contamination and exposure of wound , result ing in less infection . However , the antibiotic prophylaxis is still widely practice d , like in our institute , a continuation of the era of open surgery . Recent studies reveal no advantage of routine use of antibiotic , and there is growing consensus against it . Besides cost , antibiotic increases emergence of multidrug resistance . Because of the controversies , we conducted this clinical trial . METHODS This r and omized clinical trial , conducted from October 1 , 2009 to September 31 , 2010 at Patan Hospital , included 154 patients in prophylactic antibiotic group ( GrAP ) with cefazolin 1 g IV  as per existing practice and 156 in  no antibiotic group ( GrAPn ) . Symptomatic laparoscopic cholecystectomy patients of American Society of Anesthesiologist ( ASA ) 1 and 2 ( without diabetes ) were included . Patients with complicated gall stones ( cholangitis , choledocholithiasis , and pancreatitis ) and who required conversion were excluded . Wound was observed during follow-up within 1 week . Data on patient characteristics , use of antibiotic , bile spillage , and postoperative wound infection were entered in pre design ed proforma . Microsoft Excel was used to analyze the data . RESULTS In total , 310 patients were eligible for analysis , 154 in GrAP and 156 in GrAPn . Both groups were comparable in patient demographic and clinical characteristics such as average age ( 40.3 vs. 41.6 years ) and sex ( female 77.6 % vs. 78.6 % ) .  Overall wound infection occurred in 4.8 % ( 15/310 ) . There was no significant difference in wound infections among the two groups ( p = 0.442 ) : GrAP 3.9 % and GrAPn 5.8 % . There was no mortality in this series . CONCLUSION Routine preoperative antibiotic prophylaxis is not necessary in low-risk symptomatic gallstone patients undergoing laparoscopic cholecystectomy Septic complications are rare following laparoscopic cholecystectomy if prophylactic antibiotics are given , as demonstrated in previous studies . Antibiotic treatment may be unnecessary and , therefore , undesirable , so we compared two forms of prophylaxis : a cephalosporin antibiotic and bag extraction of the dissected gallbladder . A total of 76 patients undergoing laparoscopic cholecystectomy were r and omised to either receive an antibiotic or to have their gallbladder removed from the abdomen in a plastic bag . Complicated cases were excluded . There was a total of 6 wound infections ( 7.9 % ) , 3 in each of the study groups . All these were associated with skin commensals . There were no other septic complications . Bacteriological studies grouped the organisms isolated from the bile and the wound as potential pathogens and likely commensals . A total of 10 potential pathogens were isolated , 9 of which were found in the group receiving antibiotics . We conclude that septic sequelae of uncomplicated laparoscopic cholecystectomy are uncommon , but clearly not entirely prevented by antibiotic or mechanical prophylaxis . Prophylactic antibiotics may not be required in uncomplicated laparoscopic cholecystectomy . Further study is warranted 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 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 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 Premise and Objective : Elective laparoscopic cholecystectomy ( LC ) has low risk for post-operative infectious complications ; still most clinicians use persistent post-operative prophylactic antibiotics out of habit , tradition , or simply as defensive practice due to evolving medicolegal implication s of a large number of surgeries being showcased as daycare or next day discharge procedures . This r and omised prospect i ve trial was done to test the need for such prophylaxis in cases of elective LC in a rural/semi-urban setting . Material s and Methods : Two hundred and ten successive patients undergoing elective LC were r and omised into groups receiving single dose of injection ceftriaxone at the time of induction of anaesthesia , ( Group A = 112 cases ) and those who in addition to above received injection ceftriaxone twice daily for 2 days postoperatively ( Group B = 98 cases ) . Post-operative infectious complications between two groups were compared for variables such as age , sex , body mass index and bile/stone spillage . Results : There was no significant difference in surgical site infection rates between the groups for variables such as age , sex , body mass index , duration of symptoms , American Society of Anesthesiologists grade , duration of surgery and hospital stay . Intraoperative spillage of stones ( 9.8 % [ A ] : 5.1 % [ B ] ) did not increase infectious complications even in the presence of positive bile culture ( Group A , N = 7 vs. Group B , N = 3 ) . An operative time of greater than 60 min was found to be associated with increased surgical site infection ( P = 0 . 0006 ) . Conclusion : Single dose of ceftriaxone at the time of induction is adequate prophylaxis following elective LC even in the rural/semi-urban Indian setting and routine continued administration of antibiotic should be ab and oned as it contributes to adverse reactions , drug resistance and unnecessary financial burden 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 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 HYPOTHESIS The need for antibiotic treatment when performing elective laparoscopic cholecystectomy may not be as important as it is thought . This study assesses the real efficacy of antibiotic prophylaxis in elective laparoscopic cholecystectomy  with respect to the postoperative infection rate . DESIGN A prospect i ve r and omized study on the routine use of antibiotic prophylaxis in laparoscopic cholecystectomy . SETTING University teaching hospital , La Sapienza , Italy . PATIENTS Eighty-four patients r and omly placed into 2 groups ( A [ n = 44 ] and B [ n = 40 ] ) immediately before undergoing laparoscopic cholecystectomy . METHODS Before anesthesia was administered , group A received intravenously 2 g of cefotaxime sodium diluted in 100 mL of isotonic sodium chloride solution ; group B , 10 mL of isotonic sodium chloride solution in 100 mL of saline . A gallbladder bile sample for culture was withdrawn intraoperatively from all patients . In both groups , age , sex , weight , duration of surgery , presence of diabetes , American Society of Anesthesiologists patient classification score , preoperative autologous blood donation , antibiotic administration , intraoperative gallbladder rupture , findings from bile culture positive for bacteria , episodes of colic within 30 days before surgery , length of postoperative hospital stay , and number of septic complications were recorded . All data were correlated by univariate and multivariate analyses with the onset of septic phenomena . RESULTS In group A , 3 cases of wound infection , 1 case of subhepatic abscess from bile leakage , and 1 case of urinary tract infection were observed ; group B , 4 cases of wound infection , 1 case of bronchopneumonia , and 2 cases of urinary tract infection . Comparison of data showed no statistically significant difference between the groups . Findings from bile examination in patients with sepsis complications were positive in 5 patients in group A and in 6 in group B ( P = .91 ) . Multivariate analysis showed diabetes mellitus and colic episodes within 30 days before surgery as independent factors significantly associated to the onset of infectious complications . CONCLUSIONS In elective laparoscopic cholecystectomy , antibiotic treatment did not seem to affect the incidence and severity of infections or the degree of bile contamination BACKGROUND  Laparoscopic cholecystectomy ( LC ) is the gold st and ard for the treatment of symptomatic gallbladder stones . As infections are rare in uncomplicated LC , it is widely accepted that prophylactic antibiotics need not be administered , and guidelines do not support routine antibiotic prophylaxis during elective LC . However , routine antibiotic prophylaxis for elective LC is still popular in many clinical setting s. We investigated this situation in our department . METHOD This r and omized double-blind controlled study included 570 patients who underwent LC between March 2007 and February 2010 . The exclusion criteria were antibiotic intake before surgery , steroid treatment , and the presence of pancreatitis , cholangitis , obstructive jaundice , cephalosporin allergy , or pregnancy . The patients were r and omized into three groups . Group 1 ( n = 193 ) received physiologic saline as placebo , Group 2 ( n = 191 ) received a first-generation cephalosporin ( cefazolin ; 1 g ) , and Group 3 ( n = 186 ) received a second-generation cephalosporin ( cefuroksim aksetil ; 750 mg ) . Bile and epigastric and umbilical port tissue sample s were harvested for culture . All patients were observed until the end of the fourth week after surgery . Patient age , sex , weight , American Society of Anesthesiologists ( ASA ) score , diabetes mellitus , smoking history , history of biliary colic in the past month , length of the hospital stay before the operation , operational findings ( acute or chronic cholecystitis ) , operation duration , use of drainage , type of prophylaxis administered if any , culture results , surgical site infection ( SSI ) development , and time to SSI development along with associated treatments were evaluated . RESULTS There was no statistically significant difference between the groups with respect to any of the demographic and clinical features analyzed in this study . The SSI rate was 1.2 % in total , and in Groups 1 , 2 , and 3 , it was 1.5 % , 1.04 % , and 1.07 % , respectively . There was no statistical difference regarding SSI among the groups ( p = 1.00 ) . Superficial SSI was observed in all groups , and in all patients , the site of infection was the entrance to the epigastric port through which the gallbladder had been removed . CONCLUSIONS Surgical site infection is rare after LC , and antibiotic prophylaxis does not appear to affect the outcome significantly . Moreover , factors such as positive bile cultures , history of biliary attack , ASA score , diabetes , obesity , and smoking do not have any effect on SSI development . Thus , we conclude that antibiotic prophylaxis is not needed for elective LC INTRODUCTION It has been demonstrated previously that the identification of bactibilia during cholecystectomy is associated with the presence of one or more risk factors : acute cholecystitis , common duct stones , emergency surgery , intraoperative findings and age > 70 years . Current evidence -based guidance on antibiotic prophylaxis during  laparoscopic cholecystectomy ( LC ) is based on elective procedures and does not take into account these factors . The aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint . METHODS One hundred consecutive patients undergoing LC under the care of a single consultant surgeon during a one-year period were studied prospect ively . Data collected included patient demographics ( age , sex ) as well as details of the history of gallstone disease to determine those with complex disease and risk factors for bactibilia . A single dose of antibiotics ( second generation cephalosporin and metronidazole ) was administered on induction to patients with a risk factor present . Information relating to all radiologically or microbiologically confirmed infections was documented . RESULTS Eighty-four of the patients were female and the mean age was 47.7 ±16.0 years . Nineteen LCs were performed as emergencies and the remainder were elective procedures . A risk factor for bactibilia was present in 35 patients . A wound infection was identified in four cases , two of which were Staphylococcus aureus ( one methicillin resistant ) , one was a coagulase negative Staphylococcus and one wound cultured a mixed anaerobic growth . Three of the infections occurred in patients receiving prophylaxis ( 2 staphylococcal and 1 anaerobic ) at intervals of 7 , 14 and 19 days respectively . One patient with a body mass index of 32kg/m² in the ' no prophylaxis ' group developed a coagulase negative staphylococcal infection at 10 days . No intra or extra-abdominal abdominal infections were identified . CONCLUSIONS This study has demonstrated that restricting antibiotic prophylaxis to high risk patients has no detrimental effects in terms of increasing the rate of infections in those with no risk factors . Furthermore , the act of not prescribing to low risk patients will limit costs and the risk of adverse events . It will also reduce the risk of resistance and clostridial infections in this cohort The incidence of surgical infections  after laparoscopic cholecystectomy is reported to be < 2 % , because of the minimal trauma due to this approach . We report the results of a prospect i ve study of antibiotic prophylaxis in laparoscopic cholecystectomy , comparing ceftriaxone vs ceftazidime .  From Jan 1 to Dec 31 2002 a consecutive series of 242 cholecystectomies were performed , consisting in 18 open cholecystectomies and 224 laparoscopic cholecystectomies , 7 of which ( 3.1 % ) were converted to open cholecystectomies for technical and /or anatomical reasons . One hundred and eleven patients received 1 g i.v . ceftazidime 1 h before surgery , and 105 patients 1 g i.v . ceftriaxone on an alternate basis . Thirty-nine patients ( 17.4 % ) with acute cholecystitis received at least one booster dose at the end of the operation ; 30 out of 39 were given further therapy for 2 - 3 days , i.e. 1 g i.v . bid . Twenty-two patients treated elsewhere with ceftriaxone or ceftazidime before surgery were transferred to another prophylactic regimen . The final diagnosis in the laparoscopic cholecystectomy group was 219 bile stones , 3 adenomas , and 2 occult carcinomas .  We had 4 complications ( 1.8 % of 217 laparoscopic cholecystectomies ) , 2 of which were minor ( infection of the umbilical access by S. aureus ) and 2 major ( 1 biliary fistula [ accessory duct ] and 1 acute pancreatitis ) , both treated conservatively . Positive bile cultures ( 27 cases ) were unrelated to the clinical course . The incidence of infections after laparoscopic cholecystectomy in our prospect i ve series was < 2 % . Ceftriaxone is confirmed as the gold st and ard in biliary tract surgery , but ceftazidime was equivalent ( no statistical difference between the two antibiotics , P=0.59 NS ) . Ultra-short prophylaxis is enough in most cases , except in cholecystitis . We found no correlation between positive bile cultures and surgical infections after laparoscopic cholecystectomy . The umbilicus was the preferred site of infection in obese patients after the laparoscopic procedure . Major complications are usually related to technical pitfalls Background In patients with symptomatic cholelithiasis ,  laparoscopic cholecystectomy  ( LC ) is the st and ard method of treatment . Laparoscopic cholecystectomy has a low rate of postoperative infections probably owing to smaller wounds and minimal tissue damage compared with the open procedure . Objectives This study assessed the effect of cefazolin prophylaxis on postoperative infection in patients undergoing elective laparoscopic cholecystectomy .  Additionally , we determined the risk factors of cases with postoperative infection . Patients and Methods A total of 753 patients were enrolled in the study . Among these , 206 were excluded from the study . As a result , 547 patients with symptomatic cholelithiasis who underwent elective laparoscopic cholecystectomy were selected for this prospect i ve study . Patients were r and omized consecutively and divided into 2 groups : patients in the cefazolin ( CEF ) group ( n = 278 ) received 1 g of cefazolin and those in the control group ( n = 269 ) received 10 mL of isotonic sodium chloride solution . Patient characteristics and overall surgical outcomes were compared between the groups . All patients were followed for development of postoperative infections . Results Postoperative infections occurred in 4 patients in the CEF group and in 2 patients in the control group ; no significant difference existed in this regard(P = .44 ) . Risk of infection increased in patients with previous cholecystitis and /or endoscopic retro grade cholangiopancreatography ( P < 0.001 ) , patients with ruptured gallbladders , and patients for whom a suction drain was used ( respectively , P < 0.001 and P < 0.001 ) . Conclusions No correlation existed between cefazolin prophylaxis and postoperative infections in elective laparoscopic cholecystectomy patients . There may be an increased risk of infection in patients with previous cholecystitis or endoscopic retro grade cholangiopancreatography . In addition , there was an increased risk of postoperative infection in patients with gallbladder rupture and suction drain use 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 Postoperative infection following cholecystectomy poses a significant threat to recovery , with major cost repercussions . Though antimicrobial prophylaxis is commonly practice d , its value - particularly in laparoscopic cholecystectomy - has not yet been adequately documented . METHOD In a prospect i ve multicenter quality assurance study in 28 German hospitals , an analysis of data collected on 4,477 patients undergoing conventional ( n = 1,349 ) or laparoscopic ( n = 3,128 ) cholecystectomy was performed ; 2,217 patients received and 2,260 did not obtain perioperative antibiotic cover .  RESULTS Postoperative infections occurred in a total of 136 patients , with infection rates of 5.0 % in those without prophylaxis , 0.8 % in those on ceftriaxone , and 1.2 % in those on other antibiotic regimens . Patients receiving prophylaxis fared significantly better than those with no prophylaxis in terms of the rate of postoperative wound infections , chest infections , other complications , reoperation and mortality . CONCLUSION Neither laparoscopic nor conventional open cholecystectomy should be performed without adequate perioperative antimicrobial prophylaxis in future , especially since such measures also reduce hospital stay and hence the costs Abstract Background : Laparoscopic cholecystectomy using low-pressure pneumoperitoneum ( 8 mmHg ) minimizes adverse hemodynamic effects , reduces postoperative pain , and accelerates recovery . Similar cl aims are made for gasless laparoscopy using abdominal wall lifting . The aim of this study was to compare gasless laparoscopic cholecystectomy to low-pressure cholecystectomy with respect to postoperative pain and recovery . Methods : Thirty-six patients were r and omized to low-pressure or gasless laparoscopic cholecystectomy using a subcutaneous lifting system ( Laparotenser ) .  Results : The characteristics of the patients were similar in the two groups . The procedure was completed in all patients in the low-pressure group , but two patients in the gasless group were converted to pneumoperitoneum . There were no significant differences in postoperative pain and analgesic consumption , but patients in the gasless group developed shoulder pain more frequently ( 50 % vs 11 % , p < 0.05 ) . Gasless operation took longer to perform ( 95 vs 72.5 min , p= 0.01 ) . Conclusions : Gasless and low-pressure laparoscopic cholecystectomy were similar with respect to postoperative pain and recovery . The gasless technique provided inferior exposure and the operation took longer , but the technique may still have value in high-risk patients with cardiorespiratory disease BACKGROUND Emergency laparoscopic cholecystectomy has been advocated for the treatment of acute cholecystitis ; however it can be a difficult task , especially in public hospitals , with relatively high conversion and complication rates . Percutaneous cholecystostomy is a simple and effective procedure allowing patients to recover from the acute event and undergo elective laparoscopic surgery at a later stage . METHODS We prospect ively assessed a protocol of initial conservative treatment in patients admitted with acute cholecystitis . Patients who did not respond to medical treatment were treated by percutaneous cholecystostomy .  Following discharge the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary . The details of the operation were collected with emphasis on complications and conversion rate . RESULTS During a 3-year period , 224 patients who were admitted with acute calculous cholecystitis entered the protocol . Fifty-four patients did not improve under medical treatment and percutaneous cholecystostomy was performed . In spite of adequate drainage , 5 patients still did not improve : 3 patients were successfully operated upon urgently and recovered , while 2 patients who had severe concomitant diseases and multi-organ failure , died . Forty-nine patients were discharged with the catheter and later re-evaluated for elective operation . In 7 patients common bile duct stones were found and were removed by ERCP prior to the elective operation . Twenty-five patients underwent delayed laparoscopic cholecystectomy with a low conversion rate ( 8 % ) , and only minor complications ( 16 % ) . CONCLUSIONS Conservative treatment and delayed operation is still an acceptable choice in the treatment of acute cholecystitis . Percutaneous cholecystostomy is an effective tool , with high success rate and low morbidity , and allows for better pre-operative evaluation of the biliary system and safe interval laparoscopic surgery . Laparoscopic cholecystectomy after drainage of the gall bladder is a low morbidity procedure with relatively low conversion rate Objective : Acute cholecystitis is a common disease , and laparoscopic surgery is the st and ard of care . Background : Optimal timing of surgery for acute cholecystitis remains controversial : either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics . Methods : The ACDC ( “ Acute Cholecystitis — early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy ” ) study is a r and omized , prospect i ve , open-label , parallel group trial . Patients were r and omly assigned to receive immediate surgery within 24 hours of hospital admission ( group ILC ) or initial antibiotic treatment , followed by delayed laparoscopic cholecystectomy at days 7 to 45 ( group DLC ) . For infection , all patients were treated with moxifloxacin for at least 48 hours . Primary endpoint was occurrence of predefined relevant morbidity within 75 days . Secondary endpoints were as follows : ( 1 ) 75-day morbidity using a scoring system ; ( 2 ) conversion rate ; ( 3 ) change of antibiotic therapy ; ( 4 ) mortality ; ( 5 ) costs ; and ( 6 ) length of hospital stay . Results : Morbidity rate was significantly lower in group ILC ( 304 patients ) than in group DLC ( 314 patients ): 11.8 % versus 34.4 % . Conversion rate to open surgery and mortality did not differ significantly between groups . Mean length of hospital stay ( 5.4 days vs 10.0 days ; P < 0.001 ) and total hospital costs ( & OV0556;2919 vs & OV0556;4262 ; P < 0.001 ) were significantly lower in group ILC . Conclusions : In this large , r and omized trial , laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs . Therefore , we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients . ( NCT00447304 A prospect i ve , r and omised and double blind study was undertaken to compare the prophylactic efficacy of ciprofloxacin and cefuroxime in 155 patients undergoing elective cholecystectomy . Patients with past history of jaundice or presence of jaundice , diabetes mellitus , common bile duct stones and previous biliary tract surgery were excluded . Patients were allocated to the following groups : group A-no antibiotic ( n = 30 ) ; group B-ciprofloxacin ( 200 mg i/v before surgical incision and a second dose after 12 hrs ) ( n + 45 ) ; group C-ciprofloxacin given only post operatively ( 200 mg i/v , 12 hourly X 2 days followed by oral 500 mg twice daily X 3 days ) ( n = 35 ) ; group D-cefuroxime ( 750 mg i/v before surgical incision and a second dose after 12 hrs ) ( n = 45 ) . Efficacy of the antibiotic was defined as a patient being free of post operative wound infection . Maximum numbers of infection occurred in group A ( 26.67 % ) and group C ( 25.71 % ) . The incidence of wound infection was significantly lower when ciprofloxacin was used as prophylaxis ( group B ) than when used post operatively ( group C ) only ( P < 0.05 ) . Patients who received ciprofloxacin ( group B ) and cefuroxime ( group D ) as prophylaxis had significantly reduced incidence of infection ( 4.44 % and 6/67 % respectively ) ; no statistically significant difference was found between these groups . Ciprofloxacin could be used as prophylactic antimicrobial in elective cholecystectomy in developing countries because of its effectiveness , economy and ready availability Introduction Accidental rupture of the gallbladder is an event which occurs in up to 20 % of laparoscopic cholecystectomies , mainly in those where dissection is difficult , or during extraction when the gallbladder is withdrawn directly through the laparoscope port . It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection . It is common practice , therefore , for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs . Objective To compare 2 groups of similar patients , to determine whether administration of antibiotics , started during surgery , is actually useful in reducing the risk of residual abscess or infection in the surgical wound . Patients and Method The study considered a total of 166 patients who had suffered accidental perforation of the gallbladder during elective laparoscopic cholecystectomy . This total was divided at r and om into 2 groups : group A ( 80 patients ) who received a dose of 1 g of Cefotaxime at the moment of gallbladder rupture , followed by 2 more doses at intervals of 8 hours in the immediate postoperative period ; and group B ( 86 patients )  who did not receive any antibiotic treatment at all . The dependent variables observed were surgical wound infection and residual abscess : and the control variables were age , sex , length of operation time , intercurrent illnesses , and American Society of Anesthesiologists ( ASA ) classification . Results Two patients ( 2.5 % ) in group A developed a surgical wound infection , against 3 cases ( 3.4 % ) in group B , the result having no statistical significance . No patients developed residual abscess . In a multivariant analysis , the following were identified as independent factors significantly associated with the onset of surgical wound infection ( P<0.001 ) : diabetes mellitus , being over 60 years of age , operation time lasting longer than 70 minutes , and ASA 3 . Conclusions Routine application of an antibiotic to patients experiencing accidental perforation of the gallbladder during laparoscopic cholecystectomy is not necessary . In the case of patients with diabetes mellitus , those who are older than 60 , or who have an ASA classification of 3 or more , or if the operation itself is likely to last more than 70 minutes , the recommendation is to start antibiotic therapy in the preoperative phase immediately before surgery The role of prophylactic antibiotics in mesh repair of inguinal hernia is unclear . A Cochrane meta- analysis in 2005 concluded that " antibiotic prophylaxis for elective inguinal hernia repair can not be firmly recommended or discarded " and " further studies are needed , particularly on the use for mesh repair . " So , we design ed a study to define the role of prophylactic antibiotics in mesh repair of inguinal hernia . We conducted a prospect i ve , r and omized , double-blind , trial comparing wound infection rates in 450 patients ( 225 received intravenous Cefazolin , 225 received a placebo ) undergoing primary inguinal hernia repair electively using polypropylene mesh . 334 patients who completed a followup period of one month were analyzed . Age , American Society of Anesthesiologists class , type of hernia , type of anesthesia , grade of surgeon , pre and postoperative hospital stay and duration of operation were recorded . CDC criteria was used to define wound infection . Groups were well matched for all preoperative variables studied . The overall infection rate was 8.7 % ( 29 out of 334 ) . The incidence of wound infection in antibiotic group was 7 % and 10.5 % in control group . One from each group developed deep surgical site infection . Most of the infections occurred between the 7th and 12th post-operative day after discharge from the hospital . Antibiotic prophylaxis was associated with decreased incidence of wound infection when compared to control group , but the difference was not statistically significant . Based on our results we do not recommend the routine use of antibiotic prophylaxis in elective mesh repair of inguinal hernias Abstract Background There is a variation in the administration of antibiotics prophylaxis to reduce the perceived risk of SSI in patients undergoing non-emergency cholecystectomy . The aim of this study was to determine the effectiveness of antibiotic prophylaxis following non-emergency cholecystectomy to prevent 30-day superficial surgical site infections ( SSIs ) using non-selected , nationally collected , prospect i ve data . Methods Data were extracted from the CholeS study , which examined and independently vali date d the outcomes on consecutive patients following non-emergency cholecystectomy across 166 hospitals in the UK and Irel and . Patients who received antibiotic prophylaxis were exact matched to those who did not on variables associated with antibiotic prophylaxis . The primary outcome of interest was superficial SSI , and secondary outcomes included deep SSI , readmissions , complications and re- interventions within 30 days . Results Out of a total of 7327 patients included in the study , 4468 ( 61 % ) received antibiotic prophylaxis . These were matched to patients who did not receive antibiotic prophylaxis on a range of demographic and surgical factors , leaving 1269 pairs of patients for analysis . Within this cohort , patients receiving antibiotic prophylaxis had significantly lower rates of superficial SSI ( 0.7 % vs. 2.3 % , p = 0.001 ) and all-cause complications ( 5.8 vs. 8.0 % , p = 0.031 ) , but similar rates of deep SSI ( 1.0 vs. 1.4 % , p = 0.473 ) , readmissions ( 5.2 vs. 6.2 % , p = 0.302 ) and re- interventions ( 2.6 vs. 3.7 % , p = 0.093 ) . The number needed to treat to prevent one superficial SSI was 45 ( 95 % confidence interval 24–662 ) . Conclusions Antibiotics appear effective at reducing SSI after non-emergency cholecystectomy . However , due to the high number needed to treat it is unclear whether they provide a worthwhile clinical benefit to patients IMPORTANCE The effect of surgeons ' disrupted sleep on patient outcomes is not clearly defined . OBJECTIVE To assess if surgeons operating the night before have more complications of elective surgery performed the next day . DESIGN , SETTING , AND PARTICIPANTS Population -based , matched , retrospective cohort study using administrative health care data bases in Ontario , Canada ( 2012 population , 13,505,900 ) . Participants were 2078 patients who underwent elective laparoscopic cholecystectomies performed by surgeons who operated the night before , matched with 4 other elective laparoscopic cholecystectomy recipients ( n = 8312 ) . EXPOSURE In total , 94,183 eligible elective laparoscopic cholecystectomies were performed between 2004 and 2011 . Of these surgeries , there were 2078 procedures in which 331 different surgeons across 102 community hospitals had operated between midnight and 7 am the night before . Each " at-risk " surgery was r and omly matched with 4 other elective laparoscopic cholecystectomies ( n = 8312 ) performed by the same surgeon , who had no evidence of having operated the night before . MAIN OUTCOMES AND MEASURES The primary outcome was conversion from a laparoscopic cholecystectomy to open cholecystectomy . Secondary outcomes included evidence of iatrogenic injuries or death . Risks were quantified using generalized estimating equations . RESULTS No significant association was found in conversion rates to open operations between surgeons when they operated the night before compared with when they did not operate the previous night ( 46/2031 [ 2.2 % ] vs 157/8124 [ 1.9 % ] ; adjusted odds ratio [ OR ] , 1.18 ; 95 % CI , 0.85 - 1.64 ) . There was no association between operating the night before vs not operating the night before , and risk of iatrogenic injuries ( 14/2031 [ 0.7 % ] vs 72/8124 [ 0.9 % ] ; adjusted OR , 0.77 ; 95 % CI , 0.43 - 1.37 ) or death ( ≤5/2031 [ ≤0.2 % ] vs 7/8124 [ 0.1 % ] ) . CONCLUSIONS AND RELEVANCE No significant association was found between operating the night before and not operating the previous night for conversion to open cholecystectomy , risk of iatrogenic complications , or death for elective daytime cholecystectomy . These findings do not support safety concerns related to surgeons operating the night before performing elective surgery OBJECTIVE Patients who undergo laparoscopic cholecystectomy may be at risk of experiencing postoperative nausea and vomiting . This prospect i ve , r and omized , double-blind study compared the prophylactic use of metoclopramide and ondansetron for the treatment of postoperative nausea and vomiting in patients who underwent elective laparoscopic cholecystectomy . METHODS Eighty patients were r and omized into two groups . Patients received ondansetron 4 mg or metoclopramide 10 mg intravenously in a double-blind manner at the end of anaesthesia . RESULTS The incidence of nausea was 45 % for metoclopramide and 20 % for ondansetron in the 24 hours postoperatively ; the difference was statistically insignificant ( p = 0.05 ) . Postoperative nausea score did not show any significant difference between the two group in the first 2 hours ( p = 0.3 ) and 4 hours ( p = 0.12 ) but was significant between 4 and 24 hours ( p = 0.02 ) . The incidence of vomiting was 20 % for metoclopramide and 2.5 % for ondansetron . This difference was statistically significant ( p = 0.02 ) . CONCLUSION Ondansetron 4 mg given intravenously at the end of surgery is effective for preventing vomiting after laparoscopic cholecystectomy Background : Although it has been been shown that the elevation of abdominal pressure causes splanchnic ischemia , the pathophysiological changes that occur during laparoscopic cholecystectomy are still under investigation . Our aim was to evaluate the changes in nitric oxide ( NO ) , malondialdehyde ( MDA ) , and gastric intramucosal pH ( pHi ) during laparoscopic surgery to verify whether splanchnic ischemia had occurred . Methods : Forty patients ( 11 men and 29 women ) scheduled for cholecystectomy were r and omly divided to undergo either open ( OC ) or laparoscopic cholecystectomy ( LC ) .  Repeated blood sample s were collected for the measurement of NO and MDA concentrations . End-tidal carbon dioxide ( ETCO2 ) levels were measured using a capnograph , and pHi was assessed using a tonometric nasogastric catheter . Results : Although no significant change in pH was observed in the LC group during the procedure , it decreased significantly in the OC group and then returned to normal immediately after the procedure . ETCO2 did not change in the LC group but it increased in the OC group . Although it was not statistically significant , NO concentrations were slightly increased inthe LC group . The same magnitude of increase was seen in MDA levels but it was not significant . Neither NO nor MDA levels changed in the OC group . Conclusion : LC has no adverse effects on gut perfusion . Even if the abdominal organs are hypoperfused during the procedure , compensates for this hypoperfusion so that it pulsatile NO secretion does not cause any harm . Since LC is a short procedure , the significance of these events for extended procedures still needs to be clarified
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 .