Is there a need for antibiotic cover in clean surgery like laparoscopic cholecystectomy: a prospective study

Vishwanath Pai, Sana Aboosalih, S. N. Saravana Sundaram, Ann Rhoda Abraham, K. R. Manoj Prabhu


Background: Even with a low post-operative infection complication rate in elective laparoscopic cholecystectomy (LC), most surgeons use prophylactic antibiotics out of habit. This prospective study was done to analyze the need for such prophylaxis in cases of elective LC.

Methods: 135 successive patients undergoing elective LC were included in the study. Patients were randomized into 3 groups. Group A (n=45) cases received 3 doses of injection ceftriaxone in the post op period, group B (n=48) cases received a single dose of injection ceftriaxone at the time of induction of anesthesia, and group C (n=42) cases did not receive any antibiotic pre or post operatively. Post-operative infectious complications between three groups were compared.

Results: There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, duration of surgery and hospital stay. Intraoperative spillage of bile [6.7% (A): 4.6% (B): 5.2% (C)] did not increase infectious complications.

Conclusions: Routine use of prophylactic antibiotic in a clean, uncomplicated cases of laparoscopic cholecystectomy is not required. One dose of ceftriaxone at the time of induction or 3 doses of injection ceftriaxone post operatively following elective LC even in the urban Indian setting should be abandoned as it neither reduces the rate of surgical site infection but also contributes to adverse reactions, drug resistance, and unnecessary financial burden.


Elective laparoscopic cholecystectomy, Prophylactic antibiotic, Surgical site infection

Full Text:



Fielding GA. Laparoscopic cholecystectomy, open cholecystectomy, and cholecystostomy. In: Atlas of upper gastrointestinal and hepato-pancreato-biliary surgery. Berlin: Heidelberg; Springer; 2016: 589-598.

Alli VV, Yang J, Xu J, Bates AT, Pryor AD, Talamini MA, et al. Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience. Surg Endosc. 2017;31(4):1651-8.

Solorio V, Wu A. When is acute intervention (interventional radiology/surgery) necessary for acute cholecystitis? Can acute cholecystitis be managed at home with oral antibiotics? In: Gastrointestinal Emergencies. Springer, Cham; 2019: 199-200.

Wadhwa V, Jobanputra Y, Garg SK, Patwardhan S, Mehta D, Sanaka MR. Nationwide trends of hospital admissions for acute cholecystitis in the United States. Gastroenterol Rep. 2017;5(1):36-42.

Chauhan VS, Kariholu PL, Saha S, Singh H, Ray J. Can post-operative antibiotic prophylaxis following elective laparoscopic cholecystectomy be completely done away with in the Indian setting? A prospective randomised study. J Minim Access Surg. 2018;14(3):192-6.

Smith JP, Samra NS, Ballard DH, Moss JB, Griffen FD. Prophylactic antibiotics for elective laparoscopic cholecystectomy. American Surg. 2018;84(4):576-80.

Sood P, Mahajan A, Jaryal SC. Role of perioperative antibiotics in elective low risk cholecystectomies in prevention of surgical site infections. J Evol Med Dent Sci. 2018;7(27):3099-102.

Chang WT, Lee KT, Chuang SC, Wang SN, Kuo KK, Chen JS, et al. The impact of prophylactic antibiotics on post operative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study. Am J Surg. 2006;191:721-5.

Biscione FM, Couto RC, Pedrosa TM, Neto MC. Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy. Infect Control Hosp Epidemiol. 2007;28:1103-6.

McGuckin M, Shea JA, Schwartz JS. Infection and antimicrobial use in laparoscopic cholecystectomy. Infect Control Hosp Epidemiol. 1999;20:624-6.

Lippert H, Gastinger J. Antimicrobial prophylaxis in laparoscopic and conventional cholecystectomy. Conclusions of a large prospective multicenter quality assurance study in Germany. Chemotherapy. 1998;44:355-63.

Uchiyama K, Kawai M, Onishi H, Tani M, Kinoshita H, Ueno M, et al. Preoperative antimicrobial administration for prevention of postoperative infection in patients with laparoscopic cholecystectomy. Dig Dis Sci. 2003;48:1955-9.

Shindholimath VV, Seenu V, Parshad R, Chaudhry R, Kumar A. Factors influencing wound infection following laparoscopic cholecystectomy. Trop Gastroenterol. 2003;24:90-2.

Dervisoglou A, Tsiodras S, Kanellakopoulou K, Pinis S, Galanakis N, Pierakakis S, et al. The value of chemoprophylaxis against Enterococcus species in elective cholecystectomy: A randomized study of cefuroxime vs. ampicillin-sulbactam. Arch Surg. 2006;141:1162-7.

Sarli L, Pietra N, Costi R, Grattarola M. Gallbladder perforation during laparoscopic cholecystectomy. World J Surg. 1999;23:1186-90.

Higgins A, London J, Charland S, Ratzer E, Clark J, Haun W, et al. Prophylactic antibiotics for elective laparoscopic cholecystectomy: Are they necessary? Arch Surg. 1999;134:611-3.

Procter LD, Davenport DL, Bernard AC, Zwischenberger JB. General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg. 2010;210:60-5.

Macano CAW, Griffiths EA, Vohra RS. Current practice of antibiotic prophylaxis during elective laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2017;99:216-7.

Pasquali S, Boal M, Griffiths EA. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg. 2016;103(1):27-34.

Basant RK, Kumar R, Pandey VK, Saxena A, Singh V, Madeshiya S. A comparative study of single dose preoperative antibiotic prophylaxis versus five-day conventional postoperative antibiotic therapy in patient undergoing elective surgical procedure. Int Surg J. 2019;6:409-15.