[Antibiotic prophylaxis in biliary surgery]

Prophylactic antibiotics in gallbladder surgery is designed to reduce the incidence of postoperative wound infections. Bacteria isolated from the biliary tract are generally the same as those found in the pus of wounds. Prospective and placebo-controlled trials have shown the efficacy of prophylactic antibiotics in high-risk patients presenting one or more of the following criteria: age over 70 years, recent episode of acute chollecystitis, emergency cholecystectomy, presence of common duct stones, jaundice or diabetes mellitus in patients with no risk factors for gallbladder surgery, prophylactic antibiotics may not be essential. The efficacy of antibiotics in the prevention of wound infections has been demonstrated with first, second and third generation cephalosporins, ampicillin associated with clavulanate, ureido-penicillins, aminoglycosides, sulfonamides and quinolones. A single injection of antibiotic given one hour before incision is as effective as multiple-dose regimens. Currently, the choice of antibiotic should be mainly based on its cost. There is no evidence at the present time for systematic prophylactic antibiotics in laparoscopic surgery. Endoscopic procedures of the biliary tract do not require prophylactic antibiotics when obstruction has not been demonstrated.