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Journal of Gastrointestinal Surgery

, Volume 22, Issue 7, pp 1193–1203 | Cite as

Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis

  • Juan Camilo Gomez-Ospina
  • James A. Zapata-Copete
  • Monica Bejarano
  • Herney Andrés García-Perdomo
Original Article

Abstract

Objective

To determine the effectiveness and harms of using antibiotic prophylaxis (ABP) versus placebo/no intervention in patients undergoing elective laparoscopic cholecystectomy (eLCC) to prevent surgical site infection (SSI).

Methods

We searched MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to October 2017. We included clinical trials which involved adults at low risk undergoing eLCC and compared ABP versus placebo/no intervention. The primary outcome was SSI and secondary outcomes were other infections and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about risk difference (RD) with a 95% confidence interval (CI). Heterogeneity was evaluated using the I2 test. We produced network diagrams to show the amount of evidence available for each outcome and the most frequent comparison.

Results

We included 18 studies in qualitative and quantitative analysis. The antibiotics most commonly studied were cefazolin and cefuroxime. We found high risk of detection bias in one study and attrition bias in another. Unclear risks of selection, performance, and detection bias were frequent. For SSI, we found no heterogeneity I2 = 0% and no inconsistency p = 0.9780. No significant differences were found when compared ABP versus placebo/no intervention. Cefazolin had a RD of − 0.00 (95% CI − 0.01 to 0.01). We found no differences in regular meta-analysis, with a RD of − 0.00 (95% CI − 0.01 to 0.01) as well as for intra-abdominal and distant infections. Adverse effects were only assessed in one study, without any case reported.

Conclusions

This systematic review demonstrated no differences between ABP versus placebo/no intervention when using to prevent SSI and intra-abdominal and distant infections in patients at low risk undergoing eLCC.

Keywords

Cholecystectomy Laparoscopic Antibiotic prophylaxis Systematic review Meta-analysis 

Notes

Author’s Contribution

Juan Camilo Gomez-Ospina: design, analysis, and interpretation of data for the work; drafting the work; revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

James A. Zapata-Copete: design, analysis, and interpretation of data for the work; drafting the work; revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Monica Bejarano: design, analysis, and interpretation of data for the work; drafting the work; revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Herney Andrés García-Perdomo: design, analysis, and interpretation of data for the work; drafting the work; revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Compliance with Ethical Standards

Ethics Statement

This systematic review and meta-analysis accomplish all the ethics requirements according to Helsinki declaration and all international statements.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Juan Camilo Gomez-Ospina
    • 1
    • 2
  • James A. Zapata-Copete
    • 1
    • 3
  • Monica Bejarano
    • 4
  • Herney Andrés García-Perdomo
    • 1
    • 5
  1. 1.Urological Research Group (UROGIV)Universidad del ValleCaliColombia
  2. 2.Medicine SchoolUniversidad del ValleCaliColombia
  3. 3.Epidemiology DepartmentUniversidad LibreCaliColombia
  4. 4.Surgery DepartmentClinica FarallonesCaliColombia
  5. 5.Medicine SchoolUniversidad del ValleCaliColombia

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