Accessibility / Report Error

RISK FACTORS FOR SURGICAL WOUND INFECTION AFTER ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

FATORES DE RISCO PARA INFECÇÃO DE FERIDA OPERATÓRIA APÓS COLECISTECTOMIA LAPAROSCÓPICA ELETIVA.

Gustavo de Oliveira GAMO Gabriel Sebben REICHARDT Camila Roginski GUETTER Silvania Klug PIMENTEL About the authors

ABSTRACT - BACKGROUND:

One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors.

AIM:

This study aimed to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures.

METHODS:

This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection.

RESULTS:

There were 7 (1.59%) cases of wound infection. No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection.

CONCLUSIONS:

The non-use of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

HEADINGS:
Cholecystitis; Cholelithiasis; Cholecystectomy; Laparoscopic; Surgical Wound Infection

RESUMO - RACIONAL:

Uma das formas de evitar infecção após procedimentos cirúrgicos é por meio de profilaxia antibiótica. Isso ocorre em colecistectomias com certos fatores de risco para infecção. No entanto, algumas diretrizes sugerem o uso de profilaxia antibiótica para todas as colecistectomias, embora evidências atuais não indiquem qualquer benefício dessa prática na ausência de fatores de risco.

OBJETIVO:

Avaliar a incidência de infecção em ferida operatória após colecistectomias laparoscópicas eletivas e o uso de antibioticoprofilaxia nesses procedimentos.

MÉTODOS:

Estudo retrospectivo de 439 pacientes com colecistite crônica e colelitíase, contabilizados os diferentes fatores de risco para infecção de feridas.

RESULTADOS:

Ocorreram sete casos de infecção de ferida operatória (1.59%). Nenhum esquema de antibioticoprofilaxia alterou significativamente as taxas de infecção. Foi registrada correlação estatisticamente significativa entre infecção de ferida operatória e pacientes do sexo masculino (p=0.013). Nenhum outro fator de risco analisado demonstrou correlação estatística com infecção de ferida operatória.

CONCLUSÕES:

O não emprego de antibioticoprofilaxia e outros fatores analisados não apresentaram correlação significativa para aumento da frequência de infecção de ferida operatória. Estudos com maior amostra e grupo controle sem antibioticoprofilaxia são necessários.

DESCRITORES:
Colecistite; Colelitíase; Colecistectomia Laparoscópica; Infecção da Ferida Cirúrgica

INTRODUCTION

Wound infection (WI) is one of the most common postoperative complications and its incidence depends on multiple factors, from the surgical and postoperative environment to the type of procedure and patient profile44. Costa ACD, Santa-Cruz F, Ferraz ÁAB. What’s new in infection on surgical site and antibioticoprophylaxis in surgery? Arq Bras Cir Dig. 2021;33(4):e1558. doi: 10.1590/0102-672020200004e1558.
https://doi.org/10.1590/0102-67202020000...
. Cholecystectomy is one of the most performed procedures currently, and the laparoscopic method has been replacing the open procedure as it is less invasive, with a consequent lower risk of infection, shorter hospital stay, and faster recovery3232. Warren DK, Nickel KB, Wallace AE, Mines D, Tian F, Symons WJ, Fraser VJ, Olsen MA. Risk Factors for Surgical Site Infection After Cholecystectomy. Open Forum Infect Dis. 2017;4(2):ofx036. doi: 10.1093/ofid/ofx036.
https://doi.org/10.1093/ofid/ofx036...
. In our hospital service, cholecystectomy is considered a potentially contaminated procedure, with an infection risk of less than 5%99. Hospital do Trabalhador. Protocolo de Antibioticoprofilaxia Cirúrgica. Curitiba: Núcleo se Epidemiologia e Controle de Infecção Hospitalar; 2017. p. 11.. According to the hospital’s own Antibiotic Prophylaxis Protocol, the prophylactic use of antibiotics is recommended for open cholecystectomy and high-risk laparoscopic cholecystectomy (LC) (high-risk factors include bile spillage, acute cholecystitis or pancreatitis, jaundice, pregnancy, use of intraoperative cholangiography, conversion to open surgery, immune suppression, and prosthesis implantation)99. Hospital do Trabalhador. Protocolo de Antibioticoprofilaxia Cirúrgica. Curitiba: Núcleo se Epidemiologia e Controle de Infecção Hospitalar; 2017. p. 11.. However, as certain risk factors cannot be predicted, it is customary among surgeons to perform antibiotic prophylaxis (ABP) for any cholecystectomy, even those considered to be of low risk11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568.
https://doi.org/10.2146/ajhp120568...
,44. Costa ACD, Santa-Cruz F, Ferraz ÁAB. What’s new in infection on surgical site and antibioticoprophylaxis in surgery? Arq Bras Cir Dig. 2021;33(4):e1558. doi: 10.1590/0102-672020200004e1558.
https://doi.org/10.1590/0102-67202020000...
.

In both literature and international guidelines, it is reported that the unnecessary use of antibiotics present a risk of microbial resistance and generates unnecessary expenses, and its use in clean and potentially contaminated procedures does not reduce infection rates11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568.
https://doi.org/10.2146/ajhp120568...
,1616. Martinez JL. General principles of antibiotic resistance in bacteria. Drug Discovery Today: Technologies. 2014;11:33-39. doi: 10.1016/j.ddtec.2014.02.001
https://doi.org/10.1016/j.ddtec.2014.02....
. According to Brazil’s Price Database for Health, the average price per cefazolin (1 g) dose, the most commonly used antibiotic in ABP is around US$1.281818. Ministério da Saúde. Banco de Preços de Saúde (base de dados na internet). Brasília; Ministério da Saúde; 2004 (Acesso em 14 outubro 2020). Disponível em: <Disponível em: http://bps.saude.gov.br/visao/consultaPublica/index.jsf >. Conversão conforme cotação do dólar comercial na data de acesso.
http://bps.saude.gov.br/visao/consultaPu...
. Considering the annual volume of performed procedures and the economic burden that antimicrobial therapy can represent (up to 64% of hospital pharmacological costs), the rational use of this resource is certainly beneficial2525. Santana RS, Viana Ade C, Santiago Jda S, Menezes MS, Lobo IM, Marcellini PS. The cost of excessive postoperative use of antimicrobials: the context of a public hospital. Rev Col Bras Cir. 2014;41(3):149-54. doi: 10.1590/s0100-69912014000300003.
https://doi.org/10.1590/s0100-6991201400...
.

Furthermore, the influence of some risk factors on the incidence of WI is controversial, such as bile spillage during the procedure, in cases without acute inflammation or empyema11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568.
https://doi.org/10.2146/ajhp120568...
,22. Chong JU, Lim JH, Kim JY, Kim SH, Kim KS. The role of prophylactic antibiotics on surgical site infection in elective laparoscopic cholecystectomy. Korean J Hepatobiliary Pancreat Surg. 2015;19(4):188-93. doi: 10.14701/kjhbps.2015.19.4.188.
https://doi.org/10.14701/kjhbps.2015.19....
,55. Darzi AA, Nikmanesh A, Bagherian F. The Effect of Prophylactic Antibiotics on Post Laparoscopic Cholecystectomy Infectious Complications: A Double-Blinded Clinical Trial. Electron Physician. 2016;8(5):2308-14. doi: 10.19082/2308.
https://doi.org/10.19082/2308...
,88. Guler Y, Karabulut Z, Sengul S, Calis H. The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial. Int Wound J. 2019;16(5):1164-1170. doi: 10.1111/iwj.13175.
https://doi.org/10.1111/iwj.13175...
,1010. Jain N, Neogi S, Bali RS, Harsh N. Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy. Minim Invasive Surg. 2015;2015:204508. doi: 10.1155/2015/204508.
https://doi.org/10.1155/2015/204508...
,2121. Peponis T, Eskesen TG, Mesar T, Saillant N, Kaafarani HMA, Yeh DD, Fagenholz PJ, de Moya MA, King DR, Velmahos GC. Bile Spillage as a Risk Factor for Surgical Site Infection after Laparoscopic Cholecystectomy: A Prospective Study of 1,001 Patients. J Am Coll Surg. 2018;226(6):1030-1035. doi: 10.1016/j.jamcollsurg.2017.11.025.
https://doi.org/10.1016/j.jamcollsurg.20...
,2626. Sarkut P, Kilicturgay S, Aktas H, Ozen Y, Kaya E. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. Surg Infect (Larchmt). 2017;18(5):603-609. doi: 10.1089/sur.2016.265
https://doi.org/10.1089/sur.2016.265...
,2727. Sharma N, Garg PK, Hadke NS, Choudhary D. Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Surg Infect (Larchmt). 2010;11(4):367-70. doi: 10.1089/sur.2008.084.
https://doi.org/10.1089/sur.2008.084...
,2828. Smith JP, Samra NS, Ballard DH, Moss JB, Griffen FD. Prophylactic Antibiotics for Elective Laparoscopic Cholecystectomy. Am Surg. 2018;84(4):576-580. PMID: 29712609; PMCID: PMC6468984.,2929. Usuba T, Nyumura Y, Takano Y, Iino T, Hanyu N. Clinical outcomes of laparoscopic cholecystectomy with accidental gallbladder perforation. Asian J Endosc Surg. 2017;10(2):162-165. doi: 10.1111/ases.12348.
https://doi.org/10.1111/ases.12348...
,3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
,3131. Vohra RS, Hodson J, Pasquali S, Griffiths EA; CholeS Study Group and West Midlands Research Collaborative. Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study. World J Surg. 2017;41(9):2231-2239. doi: 10.1007/s00268-017-4018-3.
https://doi.org/10.1007/s00268-017-4018-...
. The evaluation of these factors would allow eliminating unnecessary indications of ABP, thus reducing hospital costs and other consequences for the use of antibiotics.

This study aimed to analyze the influence of different risk factors and ABP usage in the occurrence of WI after elective laparoscopic cholecystectomies.

METHODS

A retrospective observational study was carried out with patients diagnosed with cholelithiasis in regular follow-up at the hospital, from September 25, 2018, to October 28, 2019. The study protocol was approved by Hospital do Trabalhador (Worker’s Hospital) Ethics Committee under Presentation Certificate for Ethical Appreciation (CAEE) nº 17016619.1.0000.5225.

Clinical and laboratory data were taken from the patients’ medical records, anesthesiology documents, and anatomopathological reports. Surgical occurrences were taken from the surgery reports. Patients aged between 18 and 70 years, diagnosed with cholelithiasis and chronic cholecystitis, who underwent elective LC, with a minimum 10-day follow-up at the Hospital’s General Surgery outpatient clinic, were included in the study.

Through evaluation of the anesthetic records, risk factors for infection were identified in patients. The analyzed factors were as follows: sex, age, body mass index (BMI), smoking, diabetes, immunosuppression, surgical procedure within 6 months prior to cholecystectomy, infection within 30 days prior to surgery, a history of jaundice, a history of acute pancreatitis, and risk score according to the American Society of Anesthesiologists (ASA). Through surgical and medical records, length of surgery, length of hospital stay, use of cholangiography, bile duct injury, use of ABP, and gallbladder ruptures were all analyzed. Through follow-up registered in medical records, cases of WI and complications that could require reoperation were analyzed. Risk factors were deemed, as per literature, a BMI 25 kg/m2 or greater, an ASA score 3 or higher, and surgery length >2 h11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568.
https://doi.org/10.2146/ajhp120568...
.

Cases in which anatomopathological analysis indicated acute cholecystitis or gallbladder empyema, cases of incomplete medical records, loss of follow-up, or other procedures performed simultaneously to cholecystectomy, unrelated to bile ducts, were excluded.

Statistical analysis was performed using the Stata 14.2 software. Primarily, the distribution pattern for continuous variables was evaluated using the Shapiro-Wilk normality test. For descriptive analysis, measurements of median trends and dispersion were expressed in mean and standard deviation (mean+SD). Continuous variables determined as non-normal were expressed in median, minimum, and maximum values (median, minimum-maximum). Categorical variables were expressed as absolute and relative frequencies. For inferred statistical analysis, the Wilcoxon tests were used for continuous dependent variables and chi-square tests for binary or categorical dependent variables. A significance level of 5% was taken into consideration for this test.

RESULTS

Data were collected from 541 patients. After application of the criteria, 102 patients were excluded, leaving a total of 439 cases selected for the study, of which 79.95% were female. The data needed to calculate BMI were absent in 115 cases; therefore, the BMI data refer to only 324 patients whose average was 29.32 (±5.20).

The risk factors found were smoking in 63 (14.35%), diabetes in 36 (8.20%), jaundice in 2 (0.46%), immunosuppression in 4 (0.91%), previous surgeries in 10 (2.28%), previous infection in 4 (0.91%), acute pancreatitis in 2 (0.46%), ASA score ≥3 in 16 (3.76%), use of intraoperative cholangiography in 6 (1.37%), bile duct injury in 1 (0.23%), and gallbladder rupture in 12 (2.73%) cases. The descriptive analysis and risk factors of these cases are shown in Table 1.

Table 1 -
Descriptive analysis and analyzed risk factors.

After applying the Shapiro-Wilk test, all continuous variables analyzed (i.e., age, BMI, length of hospital stay, and length of surgery) were defined as noncontinuous and were therefore shown as median, minimum-maximum values. Median age was defined as 46.2 years (36.2-56.8), BMI as 29.14 kg/m2 (25.71-32.38), length of surgery as 100 min (85-115), and hospital stay as 1 day (1-1). The use of ABP was also investigated, with information gathered for 418 patients. Within this group, 408 (97.61%) patients received ABP. Cefazolin was used on 403 (96.41%), cefalexin on 3 (0.72%), ceftriaxone on 1 (0.24%), and ceftriaxone combined with metronidazole on 1 (0.24%) patient. An important factor observed in this group is that 101 (24.16%) patients received ABP, regardless of presenting no risk factors for WI (excluding sex as a risk factor). The prophylactic antibiotic therapy used is described in Table 2.

Table 2 -
Prophylactic antibiotic therapy used in the analyzed sample.

Cases with an outcome of WI, which required antibiotic therapy and/or reoperation, as well as other noninfectious outcomes, which required reoperation, were analyzed. There were seven cases of WI. Four cases required reoperation, of which there was one case of infection, one case of biloma, one case of hematoma, and one case of biloma associated with hematoma. Statistical analysis showed that the incidence of WI was significantly higher for male patients (p=0.013). Another factor identified as correlated with WI was bile duct injury. There was only a single case of injury identified; however, it was followed by a case of WI (p=0.000). Among other risk factors analyzed, correlation with WI was not statistically significant. Furthermore, there was no statistically significant difference between different ABP regimens on the incidence of WI. Of the 10 cases which did not receive ABP, none developed WI. The statistical analysis of relative risk factors is shown in Table 3.

Table 3 -
Statistical analysis of risk factors for WI.

DISCUSSION

LC is considered a safe procedure, as compared to clean procedures, particularly in elective cases and on patients with no risk factors66. Ely S, Rothenberg KA, Beattie G, Gologorsky RC, Huyser MR, Chang CK. Modern Elective Laparoscopic Cholecystectomy Carries Extremely Low Postoperative Infection Risk. J Surg Res. 2020;246:506-511. doi: 10.1016/j.jss.2019.09.038.
https://doi.org/10.1016/j.jss.2019.09.03...
. Studies indicate that cholecystectomy can even be performed simultaneously with other procedures without increasing the risk of infection 33. Claus CMP, Ruggeri JRB, Ramos EB, Costa MAR, Andriguetto L, Freitas ACT, Coelho JCU. Simultaneous laparoscopic inguinal hernia repair and cholecystectomy: does it cause mesh infection? Arq Bras Cir Dig. 2021;34(2):e1600. doi: 10.1590/0102-672020210002e1600.
https://doi.org/10.1590/0102-67202021000...
. The incidence of infection is around 0.71-8.7%22. Chong JU, Lim JH, Kim JY, Kim SH, Kim KS. The role of prophylactic antibiotics on surgical site infection in elective laparoscopic cholecystectomy. Korean J Hepatobiliary Pancreat Surg. 2015;19(4):188-93. doi: 10.14701/kjhbps.2015.19.4.188.
https://doi.org/10.14701/kjhbps.2015.19....
,55. Darzi AA, Nikmanesh A, Bagherian F. The Effect of Prophylactic Antibiotics on Post Laparoscopic Cholecystectomy Infectious Complications: A Double-Blinded Clinical Trial. Electron Physician. 2016;8(5):2308-14. doi: 10.19082/2308.
https://doi.org/10.19082/2308...
,66. Ely S, Rothenberg KA, Beattie G, Gologorsky RC, Huyser MR, Chang CK. Modern Elective Laparoscopic Cholecystectomy Carries Extremely Low Postoperative Infection Risk. J Surg Res. 2020;246:506-511. doi: 10.1016/j.jss.2019.09.038.
https://doi.org/10.1016/j.jss.2019.09.03...
,88. Guler Y, Karabulut Z, Sengul S, Calis H. The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial. Int Wound J. 2019;16(5):1164-1170. doi: 10.1111/iwj.13175.
https://doi.org/10.1111/iwj.13175...
,1010. Jain N, Neogi S, Bali RS, Harsh N. Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy. Minim Invasive Surg. 2015;2015:204508. doi: 10.1155/2015/204508.
https://doi.org/10.1155/2015/204508...
,1111. Kamran K, Afridi ZU, Muqim RU, Khalil J. Does sex affect the outcome of laparoscopic cholecystectomy? A retrospective analysis of single center experience. Asian J Endosc Surg. 2013;6(1):21-5. doi: 10.1111/j.1758-5910.2012.00152.x.
https://doi.org/10.1111/j.1758-5910.2012...
,1212. Karabulut Z, Güler Y, Doğan P, Şengül S, Çaliş H. What Should be Done for Perforation of the Gallbladder During Laparoscopic Cholecystectomy: Prophylaxis or Treatment? J Laparoendosc Adv Surg Tech A. 2021;31(1):54-60. doi: 10.1089/lap.2020.0322.
https://doi.org/10.1089/lap.2020.0322...
,2020. Passos MA, Portari-Filho PE. Antibiotic prophylaxis in laparoscopic cholecistectomy: is it worth doing? Arq Bras Cir Dig. 2016;29(3):170-172. doi: 10.1590/0102-6720201600030010.
https://doi.org/10.1590/0102-67202016000...
,2121. Peponis T, Eskesen TG, Mesar T, Saillant N, Kaafarani HMA, Yeh DD, Fagenholz PJ, de Moya MA, King DR, Velmahos GC. Bile Spillage as a Risk Factor for Surgical Site Infection after Laparoscopic Cholecystectomy: A Prospective Study of 1,001 Patients. J Am Coll Surg. 2018;226(6):1030-1035. doi: 10.1016/j.jamcollsurg.2017.11.025.
https://doi.org/10.1016/j.jamcollsurg.20...
,2222. Rodríguez-Caravaca G, Gil-Yonte P, Del-Moral-Luque JA, Lucas WC, Fernández-Cebrián JM, Durán-Poveda M. Rates of Surgical Site Infection in Cholecystectomy: Comparison between a University Teaching Hospital, Madrid Region, Spain, and USA Rates. Rev Invest Clin. 2017;69(6):336-343. doi: 10.24875/RIC.17002197.
https://doi.org/10.24875/RIC.17002197...
,2626. Sarkut P, Kilicturgay S, Aktas H, Ozen Y, Kaya E. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. Surg Infect (Larchmt). 2017;18(5):603-609. doi: 10.1089/sur.2016.265
https://doi.org/10.1089/sur.2016.265...
,2727. Sharma N, Garg PK, Hadke NS, Choudhary D. Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Surg Infect (Larchmt). 2010;11(4):367-70. doi: 10.1089/sur.2008.084.
https://doi.org/10.1089/sur.2008.084...
,2828. Smith JP, Samra NS, Ballard DH, Moss JB, Griffen FD. Prophylactic Antibiotics for Elective Laparoscopic Cholecystectomy. Am Surg. 2018;84(4):576-580. PMID: 29712609; PMCID: PMC6468984.,2929. Usuba T, Nyumura Y, Takano Y, Iino T, Hanyu N. Clinical outcomes of laparoscopic cholecystectomy with accidental gallbladder perforation. Asian J Endosc Surg. 2017;10(2):162-165. doi: 10.1111/ases.12348.
https://doi.org/10.1111/ases.12348...
,3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
,3131. Vohra RS, Hodson J, Pasquali S, Griffiths EA; CholeS Study Group and West Midlands Research Collaborative. Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study. World J Surg. 2017;41(9):2231-2239. doi: 10.1007/s00268-017-4018-3.
https://doi.org/10.1007/s00268-017-4018-...
,3232. Warren DK, Nickel KB, Wallace AE, Mines D, Tian F, Symons WJ, Fraser VJ, Olsen MA. Risk Factors for Surgical Site Infection After Cholecystectomy. Open Forum Infect Dis. 2017;4(2):ofx036. doi: 10.1093/ofid/ofx036.
https://doi.org/10.1093/ofid/ofx036...
. There are a growing number of results that do not demonstrate a significant correlation between ABP in low-risk procedures and a reduction in infection rates 22. Chong JU, Lim JH, Kim JY, Kim SH, Kim KS. The role of prophylactic antibiotics on surgical site infection in elective laparoscopic cholecystectomy. Korean J Hepatobiliary Pancreat Surg. 2015;19(4):188-93. doi: 10.14701/kjhbps.2015.19.4.188.
https://doi.org/10.14701/kjhbps.2015.19....
,55. Darzi AA, Nikmanesh A, Bagherian F. The Effect of Prophylactic Antibiotics on Post Laparoscopic Cholecystectomy Infectious Complications: A Double-Blinded Clinical Trial. Electron Physician. 2016;8(5):2308-14. doi: 10.19082/2308.
https://doi.org/10.19082/2308...
,77. Gomez-Ospina JC, Zapata-Copete JA, Bejarano M, García-Perdomo HA. Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis. J Gastrointest Surg. 2018;22(7):1193-1203. doi: 10.1007/s11605-018-3739-4.
https://doi.org/10.1007/s11605-018-3739-...
,88. Guler Y, Karabulut Z, Sengul S, Calis H. The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial. Int Wound J. 2019;16(5):1164-1170. doi: 10.1111/iwj.13175.
https://doi.org/10.1111/iwj.13175...
,1919. Pasquali S, Boal M, Griffiths EA, Alderson D, Vohra RS; CholeS Study Group; West Midlands Research Collaborative. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg. 2016;103(1):27-34; discussion 34. doi: 10.1002/bjs.9904.
https://doi.org/10.1002/bjs.9904...
,2020. Passos MA, Portari-Filho PE. Antibiotic prophylaxis in laparoscopic cholecistectomy: is it worth doing? Arq Bras Cir Dig. 2016;29(3):170-172. doi: 10.1590/0102-6720201600030010.
https://doi.org/10.1590/0102-67202016000...
,2424. Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2010;(12):CD005265. doi: 10.1002/14651858.CD005265.pub2.
https://doi.org/10.1002/14651858.CD00526...
,2626. Sarkut P, Kilicturgay S, Aktas H, Ozen Y, Kaya E. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. Surg Infect (Larchmt). 2017;18(5):603-609. doi: 10.1089/sur.2016.265
https://doi.org/10.1089/sur.2016.265...
,2727. Sharma N, Garg PK, Hadke NS, Choudhary D. Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Surg Infect (Larchmt). 2010;11(4):367-70. doi: 10.1089/sur.2008.084.
https://doi.org/10.1089/sur.2008.084...
,2828. Smith JP, Samra NS, Ballard DH, Moss JB, Griffen FD. Prophylactic Antibiotics for Elective Laparoscopic Cholecystectomy. Am Surg. 2018;84(4):576-580. PMID: 29712609; PMCID: PMC6468984.,3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
,3333. Yan RC, Shen SQ, Chen ZB, Lin FS, Riley J. The role of prophylactic antibiotics in laparoscopic cholecystectomy in preventing postoperative infection: a meta-analysis. J Laparoendosc Adv Surg Tech A. 2011;21(4):301-6. doi: 10.1089/lap.2010.0436.
https://doi.org/10.1089/lap.2010.0436...
. However, there are also studies that point to a protective effect of antibiotics, leading to uncertainty44. Costa ACD, Santa-Cruz F, Ferraz ÁAB. What’s new in infection on surgical site and antibioticoprophylaxis in surgery? Arq Bras Cir Dig. 2021;33(4):e1558. doi: 10.1590/0102-672020200004e1558.
https://doi.org/10.1590/0102-67202020000...
,1414. Liang B, Dai M, Zou Z. Safety and efficacy of antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31(5):921-8. doi: 10.1111/jgh.13246.
https://doi.org/10.1111/jgh.13246...
,1717. Matsui Y, Satoi S, Hirooka S, Kosaka H, Kawaura T, Kitawaki T. Reappraisal of previously reported meta-analyses on antibiotic prophylaxis for low-risk laparoscopic cholecystectomy: an overview of systematic reviews. BMJ Open. 2018;8(3):e016666. doi: 10.1136/bmjopen-2017-016666.
https://doi.org/10.1136/bmjopen-2017-016...
,2323. Sajid MS, Bovis J, Rehman S, Singh KK. Prophylactic antibiotics at the time of elective cholecystectomy are effective in reducing the post-operative infective complications: a systematic review and meta-analysis. Transl Gastroenterol Hepatol. 2018;3:22. doi: 10.21037/tgh.2018.04.06.
https://doi.org/10.21037/tgh.2018.04.06...
,3131. Vohra RS, Hodson J, Pasquali S, Griffiths EA; CholeS Study Group and West Midlands Research Collaborative. Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study. World J Surg. 2017;41(9):2231-2239. doi: 10.1007/s00268-017-4018-3.
https://doi.org/10.1007/s00268-017-4018-...
.

In this study, the incidence of WI was 1.59%, which is consistent with known literature. The risk factors evaluated were chosen based on international guidelines, in addition to studies that found a significant correlation to WI11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568.
https://doi.org/10.2146/ajhp120568...
,44. Costa ACD, Santa-Cruz F, Ferraz ÁAB. What’s new in infection on surgical site and antibioticoprophylaxis in surgery? Arq Bras Cir Dig. 2021;33(4):e1558. doi: 10.1590/0102-672020200004e1558.
https://doi.org/10.1590/0102-67202020000...
,55. Darzi AA, Nikmanesh A, Bagherian F. The Effect of Prophylactic Antibiotics on Post Laparoscopic Cholecystectomy Infectious Complications: A Double-Blinded Clinical Trial. Electron Physician. 2016;8(5):2308-14. doi: 10.19082/2308.
https://doi.org/10.19082/2308...
,66. Ely S, Rothenberg KA, Beattie G, Gologorsky RC, Huyser MR, Chang CK. Modern Elective Laparoscopic Cholecystectomy Carries Extremely Low Postoperative Infection Risk. J Surg Res. 2020;246:506-511. doi: 10.1016/j.jss.2019.09.038.
https://doi.org/10.1016/j.jss.2019.09.03...
,88. Guler Y, Karabulut Z, Sengul S, Calis H. The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial. Int Wound J. 2019;16(5):1164-1170. doi: 10.1111/iwj.13175.
https://doi.org/10.1111/iwj.13175...
,1010. Jain N, Neogi S, Bali RS, Harsh N. Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy. Minim Invasive Surg. 2015;2015:204508. doi: 10.1155/2015/204508.
https://doi.org/10.1155/2015/204508...
,1112. Karabulut Z, Güler Y, Doğan P, Şengül S, Çaliş H. What Should be Done for Perforation of the Gallbladder During Laparoscopic Cholecystectomy: Prophylaxis or Treatment? J Laparoendosc Adv Surg Tech A. 2021;31(1):54-60. doi: 10.1089/lap.2020.0322.
https://doi.org/10.1089/lap.2020.0322...
,1313. Kharga B, Sharma BK, Singh VK, Nishant K, Bhutia P, Tamang R, Jain N. Obesity Not Necessary, Risk of Symptomatic Cholelithiasis Increases as a Function of BMI. J Clin Diagn Res. 2016;10(10):PC28-PC32. doi: 10.7860/JCDR/2016/22098.8736.
https://doi.org/10.7860/JCDR/2016/22098....
,2121. Peponis T, Eskesen TG, Mesar T, Saillant N, Kaafarani HMA, Yeh DD, Fagenholz PJ, de Moya MA, King DR, Velmahos GC. Bile Spillage as a Risk Factor for Surgical Site Infection after Laparoscopic Cholecystectomy: A Prospective Study of 1,001 Patients. J Am Coll Surg. 2018;226(6):1030-1035. doi: 10.1016/j.jamcollsurg.2017.11.025.
https://doi.org/10.1016/j.jamcollsurg.20...
,2222. Rodríguez-Caravaca G, Gil-Yonte P, Del-Moral-Luque JA, Lucas WC, Fernández-Cebrián JM, Durán-Poveda M. Rates of Surgical Site Infection in Cholecystectomy: Comparison between a University Teaching Hospital, Madrid Region, Spain, and USA Rates. Rev Invest Clin. 2017;69(6):336-343. doi: 10.24875/RIC.17002197.
https://doi.org/10.24875/RIC.17002197...
,2626. Sarkut P, Kilicturgay S, Aktas H, Ozen Y, Kaya E. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. Surg Infect (Larchmt). 2017;18(5):603-609. doi: 10.1089/sur.2016.265
https://doi.org/10.1089/sur.2016.265...
,2828. Smith JP, Samra NS, Ballard DH, Moss JB, Griffen FD. Prophylactic Antibiotics for Elective Laparoscopic Cholecystectomy. Am Surg. 2018;84(4):576-580. PMID: 29712609; PMCID: PMC6468984.,2929. Usuba T, Nyumura Y, Takano Y, Iino T, Hanyu N. Clinical outcomes of laparoscopic cholecystectomy with accidental gallbladder perforation. Asian J Endosc Surg. 2017;10(2):162-165. doi: 10.1111/ases.12348.
https://doi.org/10.1111/ases.12348...
,3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
,3131. Vohra RS, Hodson J, Pasquali S, Griffiths EA; CholeS Study Group and West Midlands Research Collaborative. Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study. World J Surg. 2017;41(9):2231-2239. doi: 10.1007/s00268-017-4018-3.
https://doi.org/10.1007/s00268-017-4018-...
,3232. Warren DK, Nickel KB, Wallace AE, Mines D, Tian F, Symons WJ, Fraser VJ, Olsen MA. Risk Factors for Surgical Site Infection After Cholecystectomy. Open Forum Infect Dis. 2017;4(2):ofx036. doi: 10.1093/ofid/ofx036.
https://doi.org/10.1093/ofid/ofx036...
. The predominant epidemiological profile in this study was consistent with the literature, with a prevalence given to female patients aged between 30 and 50 years. A recognized infection risk, i.e., a high BMI, was prevalent in this study group (median 29.14 kg/m2), which can be expected as this is also a known risk factor for the development of gallstones1313. Kharga B, Sharma BK, Singh VK, Nishant K, Bhutia P, Tamang R, Jain N. Obesity Not Necessary, Risk of Symptomatic Cholelithiasis Increases as a Function of BMI. J Clin Diagn Res. 2016;10(10):PC28-PC32. doi: 10.7860/JCDR/2016/22098.8736.
https://doi.org/10.7860/JCDR/2016/22098....
.

Among the risk factors analyzed, no significant statistical correlation was found between WI and BMI, surgery length, hospital stay, or age. This lack of correlation may be due to non-normal presentation of these factors, as there is no enough variation within such factors to show different outcomes, where the relevance of these data has already been proved11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568.
https://doi.org/10.2146/ajhp120568...
,44. Costa ACD, Santa-Cruz F, Ferraz ÁAB. What’s new in infection on surgical site and antibioticoprophylaxis in surgery? Arq Bras Cir Dig. 2021;33(4):e1558. doi: 10.1590/0102-672020200004e1558.
https://doi.org/10.1590/0102-67202020000...
,66. Ely S, Rothenberg KA, Beattie G, Gologorsky RC, Huyser MR, Chang CK. Modern Elective Laparoscopic Cholecystectomy Carries Extremely Low Postoperative Infection Risk. J Surg Res. 2020;246:506-511. doi: 10.1016/j.jss.2019.09.038.
https://doi.org/10.1016/j.jss.2019.09.03...
,88. Guler Y, Karabulut Z, Sengul S, Calis H. The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial. Int Wound J. 2019;16(5):1164-1170. doi: 10.1111/iwj.13175.
https://doi.org/10.1111/iwj.13175...
,1313. Kharga B, Sharma BK, Singh VK, Nishant K, Bhutia P, Tamang R, Jain N. Obesity Not Necessary, Risk of Symptomatic Cholelithiasis Increases as a Function of BMI. J Clin Diagn Res. 2016;10(10):PC28-PC32. doi: 10.7860/JCDR/2016/22098.8736.
https://doi.org/10.7860/JCDR/2016/22098....
,2222. Rodríguez-Caravaca G, Gil-Yonte P, Del-Moral-Luque JA, Lucas WC, Fernández-Cebrián JM, Durán-Poveda M. Rates of Surgical Site Infection in Cholecystectomy: Comparison between a University Teaching Hospital, Madrid Region, Spain, and USA Rates. Rev Invest Clin. 2017;69(6):336-343. doi: 10.24875/RIC.17002197.
https://doi.org/10.24875/RIC.17002197...
,3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
,3232. Warren DK, Nickel KB, Wallace AE, Mines D, Tian F, Symons WJ, Fraser VJ, Olsen MA. Risk Factors for Surgical Site Infection After Cholecystectomy. Open Forum Infect Dis. 2017;4(2):ofx036. doi: 10.1093/ofid/ofx036.
https://doi.org/10.1093/ofid/ofx036...
. No correlation was found either for smoking, diabetes, pancreatitis, immunosuppression, prior infection or surgery, and jaundice, or for an ASA score of ≥3. Some of these factors are recognized in literature as risk factors for WI, but they are not found in sufficient numbers to warrant an adequate statistical analysis3232. Warren DK, Nickel KB, Wallace AE, Mines D, Tian F, Symons WJ, Fraser VJ, Olsen MA. Risk Factors for Surgical Site Infection After Cholecystectomy. Open Forum Infect Dis. 2017;4(2):ofx036. doi: 10.1093/ofid/ofx036.
https://doi.org/10.1093/ofid/ofx036...
,11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568.
https://doi.org/10.2146/ajhp120568...
,2121. Peponis T, Eskesen TG, Mesar T, Saillant N, Kaafarani HMA, Yeh DD, Fagenholz PJ, de Moya MA, King DR, Velmahos GC. Bile Spillage as a Risk Factor for Surgical Site Infection after Laparoscopic Cholecystectomy: A Prospective Study of 1,001 Patients. J Am Coll Surg. 2018;226(6):1030-1035. doi: 10.1016/j.jamcollsurg.2017.11.025.
https://doi.org/10.1016/j.jamcollsurg.20...
,3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
,66. Ely S, Rothenberg KA, Beattie G, Gologorsky RC, Huyser MR, Chang CK. Modern Elective Laparoscopic Cholecystectomy Carries Extremely Low Postoperative Infection Risk. J Surg Res. 2020;246:506-511. doi: 10.1016/j.jss.2019.09.038.
https://doi.org/10.1016/j.jss.2019.09.03...
,2222. Rodríguez-Caravaca G, Gil-Yonte P, Del-Moral-Luque JA, Lucas WC, Fernández-Cebrián JM, Durán-Poveda M. Rates of Surgical Site Infection in Cholecystectomy: Comparison between a University Teaching Hospital, Madrid Region, Spain, and USA Rates. Rev Invest Clin. 2017;69(6):336-343. doi: 10.24875/RIC.17002197.
https://doi.org/10.24875/RIC.17002197...
,44. Costa ACD, Santa-Cruz F, Ferraz ÁAB. What’s new in infection on surgical site and antibioticoprophylaxis in surgery? Arq Bras Cir Dig. 2021;33(4):e1558. doi: 10.1590/0102-672020200004e1558.
https://doi.org/10.1590/0102-67202020000...
.

The incidence of gallbladder perforation was 2.73%. This value is in line with the lowest rates reported in literature, which shows a large variation ranging between 1.5 and 35.1%22. Chong JU, Lim JH, Kim JY, Kim SH, Kim KS. The role of prophylactic antibiotics on surgical site infection in elective laparoscopic cholecystectomy. Korean J Hepatobiliary Pancreat Surg. 2015;19(4):188-93. doi: 10.14701/kjhbps.2015.19.4.188.
https://doi.org/10.14701/kjhbps.2015.19....
,55. Darzi AA, Nikmanesh A, Bagherian F. The Effect of Prophylactic Antibiotics on Post Laparoscopic Cholecystectomy Infectious Complications: A Double-Blinded Clinical Trial. Electron Physician. 2016;8(5):2308-14. doi: 10.19082/2308.
https://doi.org/10.19082/2308...
,88. Guler Y, Karabulut Z, Sengul S, Calis H. The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial. Int Wound J. 2019;16(5):1164-1170. doi: 10.1111/iwj.13175.
https://doi.org/10.1111/iwj.13175...
,1010. Jain N, Neogi S, Bali RS, Harsh N. Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy. Minim Invasive Surg. 2015;2015:204508. doi: 10.1155/2015/204508.
https://doi.org/10.1155/2015/204508...
,1111. Kamran K, Afridi ZU, Muqim RU, Khalil J. Does sex affect the outcome of laparoscopic cholecystectomy? A retrospective analysis of single center experience. Asian J Endosc Surg. 2013;6(1):21-5. doi: 10.1111/j.1758-5910.2012.00152.x.
https://doi.org/10.1111/j.1758-5910.2012...
,1212. Karabulut Z, Güler Y, Doğan P, Şengül S, Çaliş H. What Should be Done for Perforation of the Gallbladder During Laparoscopic Cholecystectomy: Prophylaxis or Treatment? J Laparoendosc Adv Surg Tech A. 2021;31(1):54-60. doi: 10.1089/lap.2020.0322.
https://doi.org/10.1089/lap.2020.0322...
,2626. Sarkut P, Kilicturgay S, Aktas H, Ozen Y, Kaya E. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. Surg Infect (Larchmt). 2017;18(5):603-609. doi: 10.1089/sur.2016.265
https://doi.org/10.1089/sur.2016.265...
,2727. Sharma N, Garg PK, Hadke NS, Choudhary D. Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Surg Infect (Larchmt). 2010;11(4):367-70. doi: 10.1089/sur.2008.084.
https://doi.org/10.1089/sur.2008.084...
,2828. Smith JP, Samra NS, Ballard DH, Moss JB, Griffen FD. Prophylactic Antibiotics for Elective Laparoscopic Cholecystectomy. Am Surg. 2018;84(4):576-580. PMID: 29712609; PMCID: PMC6468984.,3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
,3131. Vohra RS, Hodson J, Pasquali S, Griffiths EA; CholeS Study Group and West Midlands Research Collaborative. Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study. World J Surg. 2017;41(9):2231-2239. doi: 10.1007/s00268-017-4018-3.
https://doi.org/10.1007/s00268-017-4018-...
. There is a possibility for underreporting, as it is a common occurrence with this procedure and may not be included in the medical records by the surgeon3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
. There was no statistically significant correlation between bile spillage and WI in cases of cholelithiasis with no acute cholecystitis, which is in accordance to other studies22. Chong JU, Lim JH, Kim JY, Kim SH, Kim KS. The role of prophylactic antibiotics on surgical site infection in elective laparoscopic cholecystectomy. Korean J Hepatobiliary Pancreat Surg. 2015;19(4):188-93. doi: 10.14701/kjhbps.2015.19.4.188.
https://doi.org/10.14701/kjhbps.2015.19....
,88. Guler Y, Karabulut Z, Sengul S, Calis H. The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial. Int Wound J. 2019;16(5):1164-1170. doi: 10.1111/iwj.13175.
https://doi.org/10.1111/iwj.13175...
,1010. Jain N, Neogi S, Bali RS, Harsh N. Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy. Minim Invasive Surg. 2015;2015:204508. doi: 10.1155/2015/204508.
https://doi.org/10.1155/2015/204508...
,2727. Sharma N, Garg PK, Hadke NS, Choudhary D. Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Surg Infect (Larchmt). 2010;11(4):367-70. doi: 10.1089/sur.2008.084.
https://doi.org/10.1089/sur.2008.084...
,3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
. This finding is important when considering the recommendation for ABP, where the rupture of the gallbladder is a factor that cannot be predicted before the procedure, which could justify ABP usage in all cholecystectomies. A characteristic of some studies that did demonstrate a statistical correlation between perforation and infection is the inclusion of cases with acute inflammation and complicated cases, with conversion for open surgery2121. Peponis T, Eskesen TG, Mesar T, Saillant N, Kaafarani HMA, Yeh DD, Fagenholz PJ, de Moya MA, King DR, Velmahos GC. Bile Spillage as a Risk Factor for Surgical Site Infection after Laparoscopic Cholecystectomy: A Prospective Study of 1,001 Patients. J Am Coll Surg. 2018;226(6):1030-1035. doi: 10.1016/j.jamcollsurg.2017.11.025.
https://doi.org/10.1016/j.jamcollsurg.20...
,2929. Usuba T, Nyumura Y, Takano Y, Iino T, Hanyu N. Clinical outcomes of laparoscopic cholecystectomy with accidental gallbladder perforation. Asian J Endosc Surg. 2017;10(2):162-165. doi: 10.1111/ases.12348.
https://doi.org/10.1111/ases.12348...
. These same studies, in turn, showed above average infection rates. This indicates that the risk factor may not be necessarily the bile itself, but its infection, so that a more inflamed and, therefore, more fragmentable and rupture prone gallbladder is just an indicator of an already complicated case1111. Kamran K, Afridi ZU, Muqim RU, Khalil J. Does sex affect the outcome of laparoscopic cholecystectomy? A retrospective analysis of single center experience. Asian J Endosc Surg. 2013;6(1):21-5. doi: 10.1111/j.1758-5910.2012.00152.x.
https://doi.org/10.1111/j.1758-5910.2012...
. As for the asymptomatic colonization of the gallbladder, there are still conflicting results regarding its role in infectious risks1010. Jain N, Neogi S, Bali RS, Harsh N. Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy. Minim Invasive Surg. 2015;2015:204508. doi: 10.1155/2015/204508.
https://doi.org/10.1155/2015/204508...
,2626. Sarkut P, Kilicturgay S, Aktas H, Ozen Y, Kaya E. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. Surg Infect (Larchmt). 2017;18(5):603-609. doi: 10.1089/sur.2016.265
https://doi.org/10.1089/sur.2016.265...
,2727. Sharma N, Garg PK, Hadke NS, Choudhary D. Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Surg Infect (Larchmt). 2010;11(4):367-70. doi: 10.1089/sur.2008.084.
https://doi.org/10.1089/sur.2008.084...
,2929. Usuba T, Nyumura Y, Takano Y, Iino T, Hanyu N. Clinical outcomes of laparoscopic cholecystectomy with accidental gallbladder perforation. Asian J Endosc Surg. 2017;10(2):162-165. doi: 10.1111/ases.12348.
https://doi.org/10.1111/ases.12348...
. It is worth pointing out that there was a case of an injured bile duct that presented a WI, which can be explained by the more aggressive intervention that may have caused the injury; however, a single isolated case cannot define a statistical correlation.

There was no significant correlation between WI and the use of ABP, as already demonstrated in the bibliography. The use of ABP has already been evaluated in multiple meta-analyses, which have not demonstrated any benefit with such practice77. Gomez-Ospina JC, Zapata-Copete JA, Bejarano M, García-Perdomo HA. Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis. J Gastrointest Surg. 2018;22(7):1193-1203. doi: 10.1007/s11605-018-3739-4.
https://doi.org/10.1007/s11605-018-3739-...
,1919. Pasquali S, Boal M, Griffiths EA, Alderson D, Vohra RS; CholeS Study Group; West Midlands Research Collaborative. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg. 2016;103(1):27-34; discussion 34. doi: 10.1002/bjs.9904.
https://doi.org/10.1002/bjs.9904...
,2424. Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2010;(12):CD005265. doi: 10.1002/14651858.CD005265.pub2.
https://doi.org/10.1002/14651858.CD00526...
,3333. Yan RC, Shen SQ, Chen ZB, Lin FS, Riley J. The role of prophylactic antibiotics in laparoscopic cholecystectomy in preventing postoperative infection: a meta-analysis. J Laparoendosc Adv Surg Tech A. 2011;21(4):301-6. doi: 10.1089/lap.2010.0436.
https://doi.org/10.1089/lap.2010.0436...
. Even in studies in which gallbladder rupture significantly increased the incidence of WI, prophylaxis had no protective effect55. Darzi AA, Nikmanesh A, Bagherian F. The Effect of Prophylactic Antibiotics on Post Laparoscopic Cholecystectomy Infectious Complications: A Double-Blinded Clinical Trial. Electron Physician. 2016;8(5):2308-14. doi: 10.19082/2308.
https://doi.org/10.19082/2308...
,3030. van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
https://doi.org/10.1089/sur.2018.195...
. However, the unnecessary use of antibiotics is commonplace. A study showed that 94.5% of professionals used ABP in elective LCs1515. Macano C, Griffiths EA, Vohra RS. Current practice of antibiotic prophylaxis during elective laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2017;99(3):216-217. doi: 10.1308/rcsann.2017.0001.
https://doi.org/10.1308/rcsann.2017.0001...
. In our study, about a quarter of the evaluated patients received ABP, despite having no risk factors that justified this approach. Infection by Clostridium difficile can represent up to 10% of surgical infections, and the use of ABP can increase the risk of this type of infection66. Ely S, Rothenberg KA, Beattie G, Gologorsky RC, Huyser MR, Chang CK. Modern Elective Laparoscopic Cholecystectomy Carries Extremely Low Postoperative Infection Risk. J Surg Res. 2020;246:506-511. doi: 10.1016/j.jss.2019.09.038.
https://doi.org/10.1016/j.jss.2019.09.03...
. As it is an infection, which is more serious and more resistant to antibiotics, the rational use of these drugs should be emphasized.

A significant risk factor related to WI was sex. According to the studies in literature, the male patients have a higher probability of having complications in surgery and getting infected55. Darzi AA, Nikmanesh A, Bagherian F. The Effect of Prophylactic Antibiotics on Post Laparoscopic Cholecystectomy Infectious Complications: A Double-Blinded Clinical Trial. Electron Physician. 2016;8(5):2308-14. doi: 10.19082/2308.
https://doi.org/10.19082/2308...
,1111. Kamran K, Afridi ZU, Muqim RU, Khalil J. Does sex affect the outcome of laparoscopic cholecystectomy? A retrospective analysis of single center experience. Asian J Endosc Surg. 2013;6(1):21-5. doi: 10.1111/j.1758-5910.2012.00152.x.
https://doi.org/10.1111/j.1758-5910.2012...
,2929. Usuba T, Nyumura Y, Takano Y, Iino T, Hanyu N. Clinical outcomes of laparoscopic cholecystectomy with accidental gallbladder perforation. Asian J Endosc Surg. 2017;10(2):162-165. doi: 10.1111/ases.12348.
https://doi.org/10.1111/ases.12348...
,3232. Warren DK, Nickel KB, Wallace AE, Mines D, Tian F, Symons WJ, Fraser VJ, Olsen MA. Risk Factors for Surgical Site Infection After Cholecystectomy. Open Forum Infect Dis. 2017;4(2):ofx036. doi: 10.1093/ofid/ofx036.
https://doi.org/10.1093/ofid/ofx036...
. Possible explanations for this correlation involve a greater inflammatory pattern of cholecystitis in males, variations in male anatomy that make the surgical procedure difficult, and a predisposition of male patients to seek health services less frequently than females, therefore receiving medical care in a much more advanced clinical stage1111. Kamran K, Afridi ZU, Muqim RU, Khalil J. Does sex affect the outcome of laparoscopic cholecystectomy? A retrospective analysis of single center experience. Asian J Endosc Surg. 2013;6(1):21-5. doi: 10.1111/j.1758-5910.2012.00152.x.
https://doi.org/10.1111/j.1758-5910.2012...
.

This study has limitations. The low number of cases of WI, which in itself is a rare event, makes statistical analysis difficult and hinders the study of isolated variables. Furthermore, the larger number of patients with ABP, comparatively with the group without ABP, precludes the presence of an effective control group to accurately assess the effectiveness of ABP. Another factor, specifically regarding gallbladder perforation, is that its incidence may be reduced by underreporting, as it depends wholly on the surgeon’s inclusion of this event in the surgical report.

CONCLUSION

Patients who undergo elective LC with few risk factors do not benefit from the use of ABP. Antibiotics should be reserved for complicated and emergency cases with high risk of infection. A larger study with a control group to assess the effectiveness of antibiotic prophylaxis is needed to further support these recommendations.

REFERENCES

  • 1
    Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568.
    » https://doi.org/10.2146/ajhp120568
  • 2
    Chong JU, Lim JH, Kim JY, Kim SH, Kim KS. The role of prophylactic antibiotics on surgical site infection in elective laparoscopic cholecystectomy. Korean J Hepatobiliary Pancreat Surg. 2015;19(4):188-93. doi: 10.14701/kjhbps.2015.19.4.188.
    » https://doi.org/10.14701/kjhbps.2015.19.4.188
  • 3
    Claus CMP, Ruggeri JRB, Ramos EB, Costa MAR, Andriguetto L, Freitas ACT, Coelho JCU. Simultaneous laparoscopic inguinal hernia repair and cholecystectomy: does it cause mesh infection? Arq Bras Cir Dig. 2021;34(2):e1600. doi: 10.1590/0102-672020210002e1600.
    » https://doi.org/10.1590/0102-672020210002e1600
  • 4
    Costa ACD, Santa-Cruz F, Ferraz ÁAB. What’s new in infection on surgical site and antibioticoprophylaxis in surgery? Arq Bras Cir Dig. 2021;33(4):e1558. doi: 10.1590/0102-672020200004e1558.
    » https://doi.org/10.1590/0102-672020200004e1558
  • 5
    Darzi AA, Nikmanesh A, Bagherian F. The Effect of Prophylactic Antibiotics on Post Laparoscopic Cholecystectomy Infectious Complications: A Double-Blinded Clinical Trial. Electron Physician. 2016;8(5):2308-14. doi: 10.19082/2308.
    » https://doi.org/10.19082/2308
  • 6
    Ely S, Rothenberg KA, Beattie G, Gologorsky RC, Huyser MR, Chang CK. Modern Elective Laparoscopic Cholecystectomy Carries Extremely Low Postoperative Infection Risk. J Surg Res. 2020;246:506-511. doi: 10.1016/j.jss.2019.09.038.
    » https://doi.org/10.1016/j.jss.2019.09.038
  • 7
    Gomez-Ospina JC, Zapata-Copete JA, Bejarano M, García-Perdomo HA. Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis. J Gastrointest Surg. 2018;22(7):1193-1203. doi: 10.1007/s11605-018-3739-4.
    » https://doi.org/10.1007/s11605-018-3739-4
  • 8
    Guler Y, Karabulut Z, Sengul S, Calis H. The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial. Int Wound J. 2019;16(5):1164-1170. doi: 10.1111/iwj.13175.
    » https://doi.org/10.1111/iwj.13175
  • 9
    Hospital do Trabalhador. Protocolo de Antibioticoprofilaxia Cirúrgica. Curitiba: Núcleo se Epidemiologia e Controle de Infecção Hospitalar; 2017. p. 11.
  • 10
    Jain N, Neogi S, Bali RS, Harsh N. Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy. Minim Invasive Surg. 2015;2015:204508. doi: 10.1155/2015/204508.
    » https://doi.org/10.1155/2015/204508
  • 11
    Kamran K, Afridi ZU, Muqim RU, Khalil J. Does sex affect the outcome of laparoscopic cholecystectomy? A retrospective analysis of single center experience. Asian J Endosc Surg. 2013;6(1):21-5. doi: 10.1111/j.1758-5910.2012.00152.x.
    » https://doi.org/10.1111/j.1758-5910.2012.00152.x
  • 12
    Karabulut Z, Güler Y, Doğan P, Şengül S, Çaliş H. What Should be Done for Perforation of the Gallbladder During Laparoscopic Cholecystectomy: Prophylaxis or Treatment? J Laparoendosc Adv Surg Tech A. 2021;31(1):54-60. doi: 10.1089/lap.2020.0322.
    » https://doi.org/10.1089/lap.2020.0322
  • 13
    Kharga B, Sharma BK, Singh VK, Nishant K, Bhutia P, Tamang R, Jain N. Obesity Not Necessary, Risk of Symptomatic Cholelithiasis Increases as a Function of BMI. J Clin Diagn Res. 2016;10(10):PC28-PC32. doi: 10.7860/JCDR/2016/22098.8736.
    » https://doi.org/10.7860/JCDR/2016/22098.8736
  • 14
    Liang B, Dai M, Zou Z. Safety and efficacy of antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31(5):921-8. doi: 10.1111/jgh.13246.
    » https://doi.org/10.1111/jgh.13246
  • 15
    Macano C, Griffiths EA, Vohra RS. Current practice of antibiotic prophylaxis during elective laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2017;99(3):216-217. doi: 10.1308/rcsann.2017.0001.
    » https://doi.org/10.1308/rcsann.2017.0001
  • 16
    Martinez JL. General principles of antibiotic resistance in bacteria. Drug Discovery Today: Technologies. 2014;11:33-39. doi: 10.1016/j.ddtec.2014.02.001
    » https://doi.org/10.1016/j.ddtec.2014.02.001
  • 17
    Matsui Y, Satoi S, Hirooka S, Kosaka H, Kawaura T, Kitawaki T. Reappraisal of previously reported meta-analyses on antibiotic prophylaxis for low-risk laparoscopic cholecystectomy: an overview of systematic reviews. BMJ Open. 2018;8(3):e016666. doi: 10.1136/bmjopen-2017-016666.
    » https://doi.org/10.1136/bmjopen-2017-016666
  • 18
    Ministério da Saúde. Banco de Preços de Saúde (base de dados na internet). Brasília; Ministério da Saúde; 2004 (Acesso em 14 outubro 2020). Disponível em: <Disponível em: http://bps.saude.gov.br/visao/consultaPublica/index.jsf >. Conversão conforme cotação do dólar comercial na data de acesso.
    » http://bps.saude.gov.br/visao/consultaPublica/index.jsf
  • 19
    Pasquali S, Boal M, Griffiths EA, Alderson D, Vohra RS; CholeS Study Group; West Midlands Research Collaborative. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg. 2016;103(1):27-34; discussion 34. doi: 10.1002/bjs.9904.
    » https://doi.org/10.1002/bjs.9904
  • 20
    Passos MA, Portari-Filho PE. Antibiotic prophylaxis in laparoscopic cholecistectomy: is it worth doing? Arq Bras Cir Dig. 2016;29(3):170-172. doi: 10.1590/0102-6720201600030010.
    » https://doi.org/10.1590/0102-6720201600030010
  • 21
    Peponis T, Eskesen TG, Mesar T, Saillant N, Kaafarani HMA, Yeh DD, Fagenholz PJ, de Moya MA, King DR, Velmahos GC. Bile Spillage as a Risk Factor for Surgical Site Infection after Laparoscopic Cholecystectomy: A Prospective Study of 1,001 Patients. J Am Coll Surg. 2018;226(6):1030-1035. doi: 10.1016/j.jamcollsurg.2017.11.025.
    » https://doi.org/10.1016/j.jamcollsurg.2017.11.025
  • 22
    Rodríguez-Caravaca G, Gil-Yonte P, Del-Moral-Luque JA, Lucas WC, Fernández-Cebrián JM, Durán-Poveda M. Rates of Surgical Site Infection in Cholecystectomy: Comparison between a University Teaching Hospital, Madrid Region, Spain, and USA Rates. Rev Invest Clin. 2017;69(6):336-343. doi: 10.24875/RIC.17002197.
    » https://doi.org/10.24875/RIC.17002197
  • 23
    Sajid MS, Bovis J, Rehman S, Singh KK. Prophylactic antibiotics at the time of elective cholecystectomy are effective in reducing the post-operative infective complications: a systematic review and meta-analysis. Transl Gastroenterol Hepatol. 2018;3:22. doi: 10.21037/tgh.2018.04.06.
    » https://doi.org/10.21037/tgh.2018.04.06
  • 24
    Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2010;(12):CD005265. doi: 10.1002/14651858.CD005265.pub2.
    » https://doi.org/10.1002/14651858.CD005265.pub2
  • 25
    Santana RS, Viana Ade C, Santiago Jda S, Menezes MS, Lobo IM, Marcellini PS. The cost of excessive postoperative use of antimicrobials: the context of a public hospital. Rev Col Bras Cir. 2014;41(3):149-54. doi: 10.1590/s0100-69912014000300003.
    » https://doi.org/10.1590/s0100-69912014000300003
  • 26
    Sarkut P, Kilicturgay S, Aktas H, Ozen Y, Kaya E. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. Surg Infect (Larchmt). 2017;18(5):603-609. doi: 10.1089/sur.2016.265
    » https://doi.org/10.1089/sur.2016.265
  • 27
    Sharma N, Garg PK, Hadke NS, Choudhary D. Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Surg Infect (Larchmt). 2010;11(4):367-70. doi: 10.1089/sur.2008.084.
    » https://doi.org/10.1089/sur.2008.084
  • 28
    Smith JP, Samra NS, Ballard DH, Moss JB, Griffen FD. Prophylactic Antibiotics for Elective Laparoscopic Cholecystectomy. Am Surg. 2018;84(4):576-580. PMID: 29712609; PMCID: PMC6468984.
  • 29
    Usuba T, Nyumura Y, Takano Y, Iino T, Hanyu N. Clinical outcomes of laparoscopic cholecystectomy with accidental gallbladder perforation. Asian J Endosc Surg. 2017;10(2):162-165. doi: 10.1111/ases.12348.
    » https://doi.org/10.1111/ases.12348
  • 30
    van Dijk AH, van der Hoek M, Rutgers M, van Duijvendijk P, Donkervoort SC, de Reuver PR, Boermeester MA. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt). 2019;20(4):298-304. doi: 10.1089/sur.2018.195.
    » https://doi.org/10.1089/sur.2018.195
  • 31
    Vohra RS, Hodson J, Pasquali S, Griffiths EA; CholeS Study Group and West Midlands Research Collaborative. Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study. World J Surg. 2017;41(9):2231-2239. doi: 10.1007/s00268-017-4018-3.
    » https://doi.org/10.1007/s00268-017-4018-3
  • 32
    Warren DK, Nickel KB, Wallace AE, Mines D, Tian F, Symons WJ, Fraser VJ, Olsen MA. Risk Factors for Surgical Site Infection After Cholecystectomy. Open Forum Infect Dis. 2017;4(2):ofx036. doi: 10.1093/ofid/ofx036.
    » https://doi.org/10.1093/ofid/ofx036
  • 33
    Yan RC, Shen SQ, Chen ZB, Lin FS, Riley J. The role of prophylactic antibiotics in laparoscopic cholecystectomy in preventing postoperative infection: a meta-analysis. J Laparoendosc Adv Surg Tech A. 2011;21(4):301-6. doi: 10.1089/lap.2010.0436.
    » https://doi.org/10.1089/lap.2010.0436

  • How to cite this article: Gamo GO, Reichardt GS, Guetter CR, Pimentel, SK. Risk factors for surgical wound infection after elective laparoscopic cholecystectomy. ABCD Arq Bras Cir Dig. 2022;35:e1655. https://doi.org/10.1590/0102-672020210002e1655

Central message

  • Patients submitted to elective laparoscopic cholecystectomy, with few risk factors, do not appear to benefit from the use of prophylactic antibiotics.

Perspectives

  • Laparoscopic cholecystectomy is considered a safe procedure, comparable to clean procedures, especially in elective cases and patients without risk factors, so antibiotic prophylaxis is not necessary in these cases, thus avoiding its costs and consequences.

  • Financial source: none

Publication Dates

  • Publication in this collection
    17 June 2022
  • Date of issue
    2022

History

  • Received
    06 Nov 2021
  • Accepted
    03 Feb 2022
Colégio Brasileiro de Cirurgia Digestiva Av. Brigadeiro Luiz Antonio, 278 - 6° - Salas 10 e 11, 01318-901 São Paulo/SP Brasil, Tel.: (11) 3288-8174/3289-0741 - São Paulo - SP - Brazil
E-mail: revistaabcd@gmail.com