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Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy.

Abstract

BACKGROUND

Cholecystectomy is a common surgical procedure. In the open cholecystectomy area, antibiotic prophylaxis showed beneficial effects, but it is not known if its benefits and harms are similar in laparoscopic cholecystectomy. Some clinical trials suggest that antibiotic prophylaxis may not be necessary in laparoscopic cholecystectomy.

OBJECTIVES

To assess the beneficial and harmful effects of antibiotic prophylaxis versus placebo or no prophylaxis for patients undergoing elective laparoscopic cholecystectomy.

SEARCH STRATEGY

We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2010), MEDLINE (1985 to August 2010), EMBASE (1985 to August 2010), SCI-EXPANDED (1985 to August 2010), LILACS (1988 to August 2010) as well as reference lists of relevant articles.

SELECTION CRITERIA

Randomised clinical trials comparing antibiotic prophylaxis versus placebo or no prophylaxis in patients undergoing elective laparoscopic cholecystectomy.

DATA COLLECTION AND ANALYSIS

Our outcome measures were all-cause mortality, surgical site infections, extra-abdominal infections, adverse events, and quality of life. All outcome measures were confined to within hospitalisation or 30 days after discharge. We summarised the outcome measures by reporting odds ratios and 95% confidence intervals (CI), using both the fixed-effect and the random-effects models.

MAIN RESULTS

We included eleven randomised clinical trials with 1664 participants who were mostly at low anaesthetic risk, low frequency of co-morbidities, low risk of conversion to open surgery, and low risk of infectious complications. None of the trials had low risk of bias. We found no statistically significant differences between antibiotic prophylaxis and no prophylaxis in the proportion of surgical site infections (odds ratio (OR) 0.87, 95% CI 0.49 to 1.54) or extra-abdominal infections (OR 0.77, 95% CI 0.41 to 1.46). Heterogeneity was not statistically significant.

AUTHORS' CONCLUSIONS

This systematic review shows that there is not sufficient evidence to support or refute the use of antibiotic prophylaxis to reduce surgical site infection and global infections in patients with low risk of anaesthetic complications, co-morbidities, conversion to open surgery, and infectious complications, and undergoing elective laparoscopic cholecystectomy. Larger randomised clinical trials with intention-to-treat analysis and patients also at high risk of conversion to open surgery are needed.

Authors+Show Affiliations

Department of Surgery, School of Medicine-Universidad de La Sabana, Fundación Abood Shaio, Campus Puente del Comun km 21 via Chia, Chia, Cundinamarca, Colombia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

21154360

Citation

Sanabria, Alvaro, et al. "Antibiotic Prophylaxis for Patients Undergoing Elective Laparoscopic Cholecystectomy." The Cochrane Database of Systematic Reviews, 2010, p. CD005265.
Sanabria A, Dominguez LC, Valdivieso E, et al. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2010.
Sanabria, A., Dominguez, L. C., Valdivieso, E., & Gomez, G. (2010). Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. The Cochrane Database of Systematic Reviews, (12), CD005265. https://doi.org/10.1002/14651858.CD005265.pub2
Sanabria A, et al. Antibiotic Prophylaxis for Patients Undergoing Elective Laparoscopic Cholecystectomy. Cochrane Database Syst Rev. 2010 Dec 8;(12)CD005265. PubMed PMID: 21154360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. AU - Sanabria,Alvaro, AU - Dominguez,Luis C, AU - Valdivieso,Eduardo, AU - Gomez,Gabriel, Y1 - 2010/12/08/ PY - 2010/12/15/entrez PY - 2010/12/15/pubmed PY - 2011/2/11/medline SP - CD005265 EP - CD005265 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 12 N2 - BACKGROUND: Cholecystectomy is a common surgical procedure. In the open cholecystectomy area, antibiotic prophylaxis showed beneficial effects, but it is not known if its benefits and harms are similar in laparoscopic cholecystectomy. Some clinical trials suggest that antibiotic prophylaxis may not be necessary in laparoscopic cholecystectomy. OBJECTIVES: To assess the beneficial and harmful effects of antibiotic prophylaxis versus placebo or no prophylaxis for patients undergoing elective laparoscopic cholecystectomy. SEARCH STRATEGY: We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2010), MEDLINE (1985 to August 2010), EMBASE (1985 to August 2010), SCI-EXPANDED (1985 to August 2010), LILACS (1988 to August 2010) as well as reference lists of relevant articles. SELECTION CRITERIA: Randomised clinical trials comparing antibiotic prophylaxis versus placebo or no prophylaxis in patients undergoing elective laparoscopic cholecystectomy. DATA COLLECTION AND ANALYSIS: Our outcome measures were all-cause mortality, surgical site infections, extra-abdominal infections, adverse events, and quality of life. All outcome measures were confined to within hospitalisation or 30 days after discharge. We summarised the outcome measures by reporting odds ratios and 95% confidence intervals (CI), using both the fixed-effect and the random-effects models. MAIN RESULTS: We included eleven randomised clinical trials with 1664 participants who were mostly at low anaesthetic risk, low frequency of co-morbidities, low risk of conversion to open surgery, and low risk of infectious complications. None of the trials had low risk of bias. We found no statistically significant differences between antibiotic prophylaxis and no prophylaxis in the proportion of surgical site infections (odds ratio (OR) 0.87, 95% CI 0.49 to 1.54) or extra-abdominal infections (OR 0.77, 95% CI 0.41 to 1.46). Heterogeneity was not statistically significant. AUTHORS' CONCLUSIONS: This systematic review shows that there is not sufficient evidence to support or refute the use of antibiotic prophylaxis to reduce surgical site infection and global infections in patients with low risk of anaesthetic complications, co-morbidities, conversion to open surgery, and infectious complications, and undergoing elective laparoscopic cholecystectomy. Larger randomised clinical trials with intention-to-treat analysis and patients also at high risk of conversion to open surgery are needed. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/21154360/Antibiotic_prophylaxis_for_patients_undergoing_elective_laparoscopic_cholecystectomy_ L2 - https://doi.org/10.1002/14651858.CD005265.pub2 DB - PRIME DP - Unbound Medicine ER -