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KMID : 1143920180220030231
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Annals of Hepato-Biliary-Pancreatic Surgery
2018 Volume.22 No. 3 p.231 ~ p.247
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Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis
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Kim Sang-Hoon
Yu Hee-Chul
Yang Jae-Do
Ahn Sung-Woo
Hwang Hong-Pil
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Abstract
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Backgrounds/Aims: The role of prophylactic antibiotics for laparoscopic cholecystectomy in low-risk patients is still unclear. This study aimed to verify the conclusion of previous meta-analyses concerning the effectiveness of antibiotic prophylaxis for elective laparoscopic cholecystectomy in low-risk patients.
Methods: Comprehensive literature searches were performed on electric databases and manual searches. Randomized controlled trials (RCTs), prospective studies, and retrospective studies comparing antibiotic prophylaxis to placebo or no antibiotics in low-risk elective laparoscopic cholecystectomy were included.
Results: This study included 28 RCTs, three prospective studies, and three retrospective studies. In RCTs, prophylactic antibiotics did not prevent deep surgical site infections (SSI) (RR 1.10, 95% confidence interval [CI] [0.45-2.69], p=0.84) but reduced SSI (RR 0.70, 95% CI [0.53-0.94], p=0.02), and superficial SSI (RR 0.58, 95% CI [0.42-0.82], p=0.01). Prospective studies showed prophylactic antibiotics did not reduce superficial SSI (RR 0.35, 95% CI [0.01-8.40], p=0.52) but reduced SSI (RR 0.12, 95% CI [0.04-0.35], p=0.0001). In retrospective studies, antibiotic prophylaxis did not reduce SSI (RR 1.59, 95% CI [0.30-8.32], p=0.58). The pooled data (12121 patients) including RCTs and prospective and retrospective studies showed that prophylactic antibiotics were not effective in preventing deep SSI (RR 1.01 95% CI [0.46-2.21], p=0.98) but effective in reducing SSI (RR 0.67, 95% CI [0.51-0.88], p=0.003) and superficial SSI (RR 0.61, 95% CI [0.45-0.83], p=0.002).
Conclusions: The use of prophylactic antibiotics is effective for reducing the incidence of SSI and superficial SSI but is not effective for preventing deep SSI in low-risk patients who underwent elective laparoscopic cholecystectomy.
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KEYWORD
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Laparoscopic cholecystectomy, Antibiotic prophylaxis, Meta-analysis
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