Meta-analysis: Antibiotic prophylaxis in elective laparoscopic cholecystectomy

Abstract

Background: Current guidelines do not support routine antibiotic prophylaxis during elective laparoscopic cholecystectomy. However, routine antibiotic prophylaxis for elective laparoscopic cholecystectomy is still popular in many clinical settings.

Aim: To evaluate the role of antibiotic prophylaxis in elective laparoscopic cholecystectomy.

Methods: Electronic databases and manual bibliographical searches (updated to April 2008) were conducted. A meta-analysis of all trials evaluating antibiotic prophylaxis in elective laparoscopic cholecystectomy was performed.

Results: Fifteen trials were included, involving 2961 patients. After pooling all the trials, 48 wound infections occurred (48/2961, 1.62%), 22 in antibiotic prophylaxis group (22/1494, 1.47%) and 26 in control group (26/1467, 1.77%). The pooled odds ratio (OR) was 0.79 (95%CI: 0.44, 1.41). Four major infections occurred (4/2961, 0.14%), 3 in antibiotic prophylaxis group (3/1494, 0.20%), and one in control group (1/1467, 0.07%). The pooled OR was 2.51 (95%CI: 0.35, 17.84). Fifteen distant infections occurred (15/2961, 0.51%), six in antibiotic prophylaxis group (6/1494, 0.40%) and nine in control group (9/1467, 0.61%). The pooled OR was 0.53 (95%CI: 0.19, 1.50). Sensitivity analyses also failed to support antibiotic prophylaxis's preventive effect.

Conclusions: Considering the absent role of antibiotic prophylaxis in reducing the infectious complications, we suggest that antibiotic prophylaxis is unnecessary and should not be routinely used in low-risk elective laparoscopic cholecystectomy patients.