Related Experiment Video
Updated: May 17, 2026
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Routine use of antibiotic prophylaxis in low-risk laparoscopic cholecystectomy is unnecessary: a randomized clinical
Jay Narayan Shah1, Shanta Bir Maharjan, Sanjay Paudyal
1Department of Surgery, Patan Hospital, Patan Academy of Health Science (PAHS), Lalitpur, Kathmandu, Nepal. drjaywufei@gmail.com
Background:
Laparoscopic cholecystectomy uses smaller incision and trocars that lessen the contamination and exposure of wound, resulting in less infection. However, the antibiotic prophylaxis is still widely practiced, 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 randomized 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 predesigned 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.
Insights
Routine preoperative antibiotic prophylaxis is not necessary for low-risk patients undergoing laparoscopic cholecystectomy. This study found no significant difference in wound infection rates between groups receiving antibiotics and those not receiving them.
Area of Science:
- Surgical Infection Prevention
- Minimally Invasive Surgery
- Antibiotic Stewardship
Background:
- Laparoscopic cholecystectomy offers benefits over open surgery, yet antibiotic prophylaxis remains common practice.
- Recent evidence suggests routine antibiotic use provides no advantage and contributes to antibiotic resistance.
- Controversies surrounding antibiotic prophylaxis in this procedure prompted this clinical trial.
Purpose of the Study:
- To evaluate the necessity of routine preoperative antibiotic prophylaxis in patients undergoing laparoscopic cholecystectomy.
- To compare postoperative wound infection rates in patients who received prophylactic antibiotics versus those who did not.
Main Methods:
- A randomized clinical trial involving 310 patients (154 prophylactic antibiotic group, 156 no antibiotic group) was conducted.
- Included were symptomatic gallstone patients (American Society of Anesthesiologist class 1 and 2, without diabetes) undergoing laparoscopic cholecystectomy.
- Excluded were patients with complicated gallstones or those requiring conversion to open surgery. Wound infections were monitored within one week post-surgery.
Main Results:
- Overall wound infection rate was 4.8% (15/310) with no statistically significant difference between the prophylactic antibiotic group (3.9%) and the no antibiotic group (5.8%) (p = 0.442).
- Patient demographics and clinical characteristics were comparable between the two groups.
- No mortality was observed during the study period.
Conclusions:
- Routine preoperative antibiotic prophylaxis is not indicated for low-risk symptomatic gallstone patients undergoing laparoscopic cholecystectomy.
- Discontinuation of routine antibiotic use in this patient population may be considered.
- This approach aligns with antibiotic stewardship principles and may reduce the emergence of multidrug resistance.
