A reevaluation of antibiotic prophylaxis in laparoscopic cholecystectomy

Antibiotic prophylaxis for cholecystectomy, although somewhat controversial, is nevertheless a routine component of surgical care. With the advent of laparoscopic cholecystectomy, this routine practice of antibiotic prophylaxis needs to be reevaluated. The present investigation was undertaken to determine the incidence of postsurgical infection in patients receiving antibiotic prophylaxis compared with patients receiving chlorhexidine gluconate scrub the evening before surgery. A total of 448 patients were enrolled in the study. Thirty-two of these patients were excluded because of the presence of intrinsic risk factors for infection. Two hundred twenty-eight patients received antibiotic prophylaxis, and 188 patients were enrolled in the non-antibiotic group. A total of 14 infections occurred in the antibiotic prophylaxis group, whereas no infections occurred in the chlorhexidine group. These results suggest that meticulous antiseptic skin cleansing is sufficient for prevention of postsurgical infection following laparoscopic cholecystectomy. Antibiotic prophylaxis should be used only in those patients exhibiting intrinsic risk factors, such as cholecystitis.