Abstract

Laparoscopic cholecystectomy uses smaller incision and trocars that lessen the contamination and exposure of wound, resulting in less infection. However, the antibiotic prophylaxis is still widely practiced, like in our institute, a continuation of the era of open surgery. Recent studies reveal no advantage of routine use of antibiotic, and there is growing consensus against it. Besides cost, antibiotic increases emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial. This randomized clinical trial, conducted from October 1, 2009 to September 31, 2010 at Patan Hospital, included 154 patients in prophylactic antibiotic group (GrAP) with cefazolin 1 g IV as per existing practice and 156 in no antibiotic group (GrAPn). Symptomatic laparoscopic cholecystectomy patients of American Society of Anesthesiologist (ASA) 1 and 2 (without diabetes) were included. Patients with complicated gall stones (cholangitis, choledocholithiasis, and pancreatitis) and who required conversion were excluded. Wound was observed during follow-up within 1 week. Data on patient characteristics, use of antibiotic, bile spillage, and postoperative wound infection were entered in predesigned proforma. Microsoft Excel was used to analyze the data. In total, 310 patients were eligible for analysis, 154 in GrAP and 156 in GrAPn. Both groups were comparable in patient demographic and clinical characteristics such as average age (40.3 vs. 41.6 years) and sex (female 77.6% vs. 78.6%). Overall wound infection occurred in 4.8% (15/310). There was no significant difference in wound infections among the two groups (p = 0.442): GrAP 3.9% and GrAPn 5.8%. There was no mortality in this series. Routine preoperative antibiotic prophylaxis is not necessary in low-risk symptomatic gallstone patients undergoing laparoscopic cholecystectomy.

Abstract

There are controversies about the benefits of prophylactic antibiotics in the prevention of postoperative surgical site infection (SSI) in mesh herniorrhaphy for a long time. This study aimed to evaluate the effectiveness and efficacy of systemic prophylactic cefazolin in prevention of wound infection in various types of hernia repair with mesh materials. This is a prospective randomized control study. We evaluated wound infection rates in 395 patients with various kinds of hernia who underwent elective mesh repair using polypropylene mesh from 2007 to 2011. A total of 237 (60.0%) patients received prophylactic cefazolin (study group) and the remaining 158 (40.0%) patients did not receive any prophylactic antibiotics (control group). Patients were followed for infection at the following periods after the operation by an independent surgeon: 10 days, 30 days, 12 months, and then annually for at least 2 years. Eight (2.03%) patients had infection in the site of surgery [2 (1.27%) in the control group and 6 (2.53%) in the study group]. The distribution of infection was not significantly different between the two groups (p = 0.364). The superficial infections were managed by drainage and irrigation. One patient from the study group developed deep SSI and was readmitted and subsequently received antibiotic therapy, drainage, and debridement. Preoperative administration of single-dose cefazolin for prosthetic hernia repairs did not markedly decrease the risk of wound infection. Our results do not support the use of cefazolin as a prophylactic antibiotic for various kinds of abdominal wall hernia repair with mesh.