Meta‐analysis: antibiotic prophylaxis in elective laparoscopic cholecystectomy

Abstract

Background Current guidelines do not support routine antibiotic prophylaxis during elective laparoscopic cholecystectomy. However, routine antibiotic prophylaxis for elective laparoscopic cholecystectomy is still popular in many clinical settings. Aim To evaluate the role of antibiotic prophylaxis in elective laparoscopic cholecystectomy. Methods Electronic databases and manual bibliographical searches (updated to April 2008) were conducted. A meta‐analysis of all trials evaluating antibiotic prophylaxis in elective laparoscopic cholecystectomy was performed. Results Fifteen trials were included, involving 2961 patients. After pooling all the trials, 48 wound infections occurred (48/2961, 1.62%), 22 in antibiotic prophylaxis group (22/1494, 1.47%) and 26 in control group (26/1467, 1.77%). The pooled odds ratio (OR) was 0.79 (95%CI: 0.44, 1.41). Four major infections occurred (4/2961, 0.14%), 3 in antibiotic prophylaxis group (3/1494, 0.20%), and one in control group (1/1467, 0.07%). The pooled OR was 2.51 (95%CI: 0.35, 17.84). Fifteen distant infections occurred (15/2961, 0.51%), six in antibiotic prophylaxis group (6/1494, 0.40%) and nine in control group (9/1467, 0.61%). The pooled OR was 0.53 (95%CI: 0.19, 1.50). Sensitivity analyses also failed to support antibiotic prophylaxis’s preventive effect. Conclusions Considering the absent role of antibiotic prophylaxis in reducing the infectious complications, we suggest that antibiotic prophylaxis is unnecessary and should not be routinely used in low‐risk elective laparoscopic cholecystectomy patients.