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Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy: A Meta-Analysis

  • 2008 plenary presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The role of prophylactic antibiotics in laparoscopic cholecystectomy in low-risk patients is controversial. We conducted a meta-analysis to evaluate the efficacy of prophylactic antibiotics in low-risk patients (those without cholelithiasis or cholangitis) undergoing laparoscopic cholecystectomy.

Methods

Multiple databases and abstracts were searched. Randomized controlled trials (RCTs) comparing prophylactic antibiotics to placebo or no antibiotics in low-risk laparoscopic cholecystectomy were included. The effects of prophylactic antibiotics were analyzed by calculating pooled estimates of overall infections, superficial wound infections, major infections, distant infections, and length of hospital stay. Separate analyses were performed for each outcome by using odds ratio or weighted mean difference. Both random and fixed effects models were used. Publication bias was assessed by funnel plot. Heterogeneity among studies was assessed by calculating I 2 measure of inconsistency.

Results

Nine RCTs (N = 1,437) met the inclusion criteria. No statistically significant reduction was noted for those receiving prophylactic antibiotics and those who did not for overall infectious complications (p = 0.20), superficial wound infections (p = 0.36), major infections (p = 0.97), distant infections (p = 0.28), or length of hospital stay (p = 0.77). No statistically significant publication bias or heterogeneity were noted.

Conclusions

Prophylactic antibiotics do not prevent infections in low-risk patients undergoing laparoscopic cholecystectomy.

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Acknowledgments

No additional acknowledgments. No grant support or external funding were utilized.

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Authors and Affiliations

  1. Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO, USA

    Abhishek Choudhary, Matthew L. Bechtold, Srinivas R. Puli & Praveen K. Roy

  2. University of New Mexico, Albuquerque, NM, USA

    Mohamed O. Othman

  3. ABQ Health Partners, 2nd Floor, Gastroenterology, 5400 Gibson Blvd SE, Albuquerque, NM, 87108, USA

    Praveen K. Roy

Authors
  1. Abhishek Choudhary
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  2. Matthew L. Bechtold
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  3. Srinivas R. Puli
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  4. Mohamed O. Othman
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  5. Praveen K. Roy
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Corresponding author

Correspondence to Praveen K. Roy.

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Discussion

John B. Marshall, M.D. (Columbia, MO): This is a practical paper that has the potential to change practice habits. A majority of surgeons presently give prophylactic antibiotics before laparoscopic cholecystectomy. While randomized controlled trials have not shown a benefit, a number of the trials have been underpowered and not included enough subjects to exclude a benefit. Meta-analysis is a statistical technique that permits the results of different studies to be combined. The results of this well-conducted meta-analysis found no benefit from prophylactic antibiotics given before laparoscopic cholecystectomy. This is an important finding given the cost implications and various other potential deleterious effects of prescribing unwarranted antibiotics. Most of the trials in this study excluded so-called high-risk patients, though the various studies tended to define high risk in various ways. Additional investigation is needed in the high-risk subset. However, the verdict seems clear in most patients undergoing laparoscopic cholecystectomy, prophylactic antibiotics are not needed.

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Choudhary, A., Bechtold, M.L., Puli, S.R. et al. Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy: A Meta-Analysis. J Gastrointest Surg 12, 1847–1853 (2008). https://doi.org/10.1007/s11605-008-0681-x

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  • DOI: https://doi.org/10.1007/s11605-008-0681-x

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