Current practice of antibiotic prophylaxis during elective laparoscopic cholecystectomy

Area of Science:

• Surgical Infections
• Gastrointestinal Surgery
• Evidence-Based Medicine

Background:

• Current guidelines do not recommend antibiotic prophylaxis for elective laparoscopic cholecystectomy.
• Population-based studies show significant variation in antibiotic prophylaxis practices during cholecystectomy.
• This discrepancy suggests a potential gap between established guidelines and clinical application.

Purpose of the Study:

• To investigate the current rationale behind antibiotic prophylaxis in elective laparoscopic cholecystectomy.
• To understand the factors influencing antibiotic prescribing decisions in this surgical context.

Main Methods:

• A survey questionnaire was distributed to surgeons and relevant professional networks.
• Data were collected from 234 respondents regarding their antibiotic prophylaxis policies and practices.
• The survey explored specific scenarios where antibiotics were used or withheld.

Main Results:

• Over 50% of respondents lacked a written policy for antibiotic prophylaxis in elective laparoscopic cholecystectomy.
• Antibiotic use varied, with 5.6% never using them, 30.8% always using them, and 63.7% using them selectively.
• Selective antibiotic use was most common in cases involving contamination with bile, stones, or pus.
• A high percentage (87%) expressed willingness to participate in trials on antibiotic effectiveness in contaminated cases.

Conclusions:

• A significant disparity exists between current clinical practice and established guidelines regarding antibiotic prophylaxis in elective laparoscopic cholecystectomy.
• This variation appears to stem from a lack of robust evidence demonstrating the efficacy of antibiotics in preventing surgical site infections, particularly in contaminated operative fields.
• Further research, including clinical trials, is necessary to address this evidence gap and inform future practice guidelines.