Elective Laparoscopic Cholecystectomy: A Clean Surgery

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Abstract Background: Laparoscopic cholecystectomy (LC) has become the gold standard procedure for treatment of cholelithiasis. It has many advantages over open cholecystectomy in terms of small incision, minimal postoperative pain, shorter hospital stays, better cosmesis and early recovery. The incidence of infectious complications after LC is significantly lower compared with open cholecystectomy. Surgical site infection (SSI), a significant postoperative complication, can lead to considerable morbidity and mortality. One approach to preventing infection is the administration of prophylactic antibiotics. However, in low-risk patients, for clean surgeries antibiotic prophylaxis does not seem to affect the incidence of SSI. In low- risk patients, eliminating the unnecessary use of prophylactic antibiotics would result in a cost reduction: moreover, it would lower the risk of adverse reaction and reduced microbial resistance. This is a prospective study conducted with total of 650 patients undergoing LC. Risk of SSI and cost effectiveness of LC compared among study groups with and without antibiotic prophylaxis and no significant difference in SSI was present in both group so LC without antibiotic prophylaxis found to be a cost-effective method of treatment of gall stone disease in selected population. Methods: After the approval of the hospital ethics committee, the observational case control study was conducted at the Dept. of Surgery, for 24 months from Sept 2022 to Aug 2024 with 650 patients. After randomization, LC have been done with antibiotic prophylaxis in control group whereas case group has not received any antibiotic prophylaxis. Patient followed up on day three, seven, days 14 and day 28 postoperatively for development of SSI. Results: There is no significant difference in SSI rate among the case and control groups and avoiding unnecessary use of antibiotics is a cost-effective method of treatment. Conclusion: The standardization of international and national guidelines for lower middle-income countries, including India, by carrying out a significant number of clinical trials and establishing recommendations, is required to prevent SSI concerning antibiotic prophylaxis and cost effectiveness of treatment.

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