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Meta-Analysis
. 2010 Dec 8;2010(12):CD005265.
doi: 10.1002/14651858.CD005265.pub2.

Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy

Alvaro Sanabria  1 , Luis C Dominguez, Eduardo Valdivieso, Gabriel Gomez
Affiliations
Meta-Analysis

Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy

Alvaro Sanabria et al. Cochrane Database Syst Rev. .

Abstract

Background: Cholecystectomy is a common surgical procedure. In the open cholecystectomy area, antibiotic prophylaxis showed beneficial effects, but it is not known if its benefits and harms are similar in laparoscopic cholecystectomy. Some clinical trials suggest that antibiotic prophylaxis may not be necessary in laparoscopic cholecystectomy.

Objectives: To assess the beneficial and harmful effects of antibiotic prophylaxis versus placebo or no prophylaxis for patients undergoing elective laparoscopic cholecystectomy.

Search strategy: We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2010), MEDLINE (1985 to August 2010), EMBASE (1985 to August 2010), SCI-EXPANDED (1985 to August 2010), LILACS (1988 to August 2010) as well as reference lists of relevant articles.

Selection criteria: Randomised clinical trials comparing antibiotic prophylaxis versus placebo or no prophylaxis in patients undergoing elective laparoscopic cholecystectomy.

Data collection and analysis: Our outcome measures were all-cause mortality, surgical site infections, extra-abdominal infections, adverse events, and quality of life. All outcome measures were confined to within hospitalisation or 30 days after discharge. We summarised the outcome measures by reporting odds ratios and 95% confidence intervals (CI), using both the fixed-effect and the random-effects models.

Main results: We included eleven randomised clinical trials with 1664 participants who were mostly at low anaesthetic risk, low frequency of co-morbidities, low risk of conversion to open surgery, and low risk of infectious complications. None of the trials had low risk of bias. We found no statistically significant differences between antibiotic prophylaxis and no prophylaxis in the proportion of surgical site infections (odds ratio (OR) 0.87, 95% CI 0.49 to 1.54) or extra-abdominal infections (OR 0.77, 95% CI 0.41 to 1.46). Heterogeneity was not statistically significant.

Authors' conclusions: This systematic review shows that there is not sufficient evidence to support or refute the use of antibiotic prophylaxis to reduce surgical site infection and global infections in patients with low risk of anaesthetic complications, co-morbidities, conversion to open surgery, and infectious complications, and undergoing elective laparoscopic cholecystectomy. Larger randomised clinical trials with intention-to-treat analysis and patients also at high risk of conversion to open surgery are needed.

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Conflict of interest statement

None known.

Figures

1
1
Funnel plot of comparison: 1 Antibiotic prophylaxis versus no‐prophylaxis, outcome: 1.1 Surgical site infection.
2
2
Funnel plot of comparison: 1 Antibiotic prophylaxis versus no‐prophylaxis, outcome: 1.2 Global infections.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Antibiotic prophylaxis versus placebo or no‐prophylaxis, Outcome 1 Surgical site infection.
1.2
1.2. Analysis
Comparison 1 Antibiotic prophylaxis versus placebo or no‐prophylaxis, Outcome 2 Extra‐abdominal infections.
1.3
1.3. Analysis
Comparison 1 Antibiotic prophylaxis versus placebo or no‐prophylaxis, Outcome 3 Surgical site infection (Intention‐to‐treat analysis worst‐best case scenario).
1.4
1.4. Analysis
Comparison 1 Antibiotic prophylaxis versus placebo or no‐prophylaxis, Outcome 4 Surgical site infection (Intention‐to‐treat analysis best‐worst case scenario).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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