The Efficacy and Safety of Using Prophylactic Antibiotics Perioperative Laparoscopic Cholecystectomy; A Prospective Observational Cohort Study

Abstract

Abstract Background: Antibiotic prophylaxis is recommended by many guidelines for laparoscopic cholecystectomy. However, the effectiveness and safety of this measure remain controversial due to the fact that most recommendations are based on old and low-quality evidence. Methods: A total of 325 patients who underwent laparoscopic cholecystectomy at Aleppo University Hospital between February 1, 2022 and November 30, 2022 were involved in the study. Inclusion criteria included: laparoscopic cholecystectomy cases, aged between 18 and 90, and patients who accepted to participate in our study. While exclusion criteria included: open cholecystectomy. Results: There was no significant difference in the difficulty of surgical work or perioperative medications between groups. Thirty Complications happened included Wound infection (N=12, PAG = 1, NAG =11; P =0.07), Urinary Tract Infection (N=4 , PAG = 1 , NAG =3 ;P=0.314), bleeding (N=2, PAG = 1, NAG =1; P=0.175), Acute pancreatitis (N=2, PAG = 1, NAG =1; P=0.175), prolonged shoulder pain (N= , PAG =0 , NAG =2 ;P=0.165), intra-abdominal abscess (N=1, PAG =0, NAG =1; P=0.198), Bile leak (N=1, PAG = 1, NAG =0; P=0.056), and other (N=8, PAG = 2, NAG =6; P=0.2). While no case of renal, respiratory (pneumonia), CVA, or Venous thromboembolism complication was recorded during the follow-up period for both groups. Thirteen patients required unplanned readmission and one death occurred in the antibiotic group. Only one case needed ICU care in the antibiotic group. There was a tendency for more complications in patients who did not receive antibiotics in most subgroups, but these results were not statistically significant and require further study with larger patient numbers to determine significance. Conclusion: The medical literature is still unable to answer whether to use PA or not. We tried to cover all possible types of LC and follow them up for a sufficient period. However, future studies with larger samples are needed to solve the debate and improve the present guidelines.