Perioperative Antimicrobial Prophylaxis in Elective and High-Risk Laparoscopic Cholecystectomy: A Narrative Review

Laparoscopic cholecystectomy (LC) is one of the most frequently performed general surgical procedures. Surgical site infection (SSI) rates are low in low-risk elective cases, yet practice variation in perioperative antimicrobial prophylaxis remains considerable. Questions persist regarding the necessity of prophylaxis. Optimising antimicrobial use in LC may represent an area of interest for antimicrobial stewardship within general surgery. A narrative review of literature published between 2010 and 2025 was conducted using MEDLINE, Embase and Cochrane databases. Randomised controlled trials, observational studies, meta-analyses and international guidelines evaluating antimicrobial use for LC were included. This review synthesised current evidence regarding SSI risk in elective and high-risk cases, compared major guidelines and explored stewardship implications. Across multiple randomised trials and meta-analyses, routine antimicrobial prophylaxis has not consistently been shown to confer a clinically meaningful reduction in SSI rates for low-risk elective LC, with reported benefits limited by heterogeneity, small absolute risk reductions and variable study quality. In high-risk LC, particularly acute cholecystitis and cases involving bile contamination or severe inflammation, baseline SSI risk is higher; however, evidence does not consistently demonstrate benefit from perioperative or postoperative antibiotics. Data for other high-risk subgroups, including patients with diabetes, obesity, immunosuppression or prolonged operative time, are limited and largely derived from observational studies. In high-risk cases, evidence remains insufficient to draw definitive conclusions, contributing to ongoing practice variation. Given the implications for antimicrobial resistance, healthcare costs and patient safety, further high-quality prospective studies focusing on clearly defined high-risk subgroups are required to inform guideline development and optimise antimicrobial stewardship. As a narrative review, this paper aims to summarise and contextualise existing evidence rather than provide definitive practice recommendations.