Antimicrobial Prophylaxis in Laparoscopic and Conventional Cholecystectomy

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Abstract
Background: Postoperative infection following cholecystectomy poses a significant threat to recovery, with major cost repercussions. Though antimicrobial prophylaxis is commonly practiced, its value – particularly in laparoscopic cholecystectomy – has not yet been adequately documented. Method: In a prospective multicenter quality assurance study in 28 German hospitals, an analysis of data collected on 4,477 patients undergoing conventional (n = 1,349) or laparoscopic (n = 3,128) cholecystectomy was performed; 2,217 patients received and 2,260 did not obtain perioperative antibiotic cover. Results: Postoperative infections occurred in a total of 136 patients, with infection rates of 5.0% in those without prophylaxis, 0.8% in those on ceftriaxone, and 1.2% in those on other antibiotic regimens. Patients receiving prophylaxis fared significantly better than those with no prophylaxis in terms of the rate of postoperative wound infections, chest infections, other complications, reoperation and mortality. Conclusion: Neither laparoscopic nor conventional open cholecystectomy should be performed without adequate perioperative antimicrobial prophylaxis in future, especially since such measures also reduce hospital stay and hence the costs.