Prophylactic antibiotics in high risk patients undergoing laparoscopic cholecystectomy.

Introduction: The Centers for Disease Control and Prevention (CDC) recommends the administration of a single dose of prophylactic antibiotics in patients undergoing clean-contaminated surgeries. \nAim: The current study was done to compare outcomes in high-risk patients undergoing Laparoscopic cholecystectomy between those who received and those who did not receive prophylactic antibiotics in the pre-operative period. \nPatients and Methods: It was a randomized controlled trial done in the Department of General Surgery of a tertiary care teaching hospital over the period of 24 months (January 2018-December 2019), after approval by the Institutional Ethics committee. Patient admitted for Laparoscopic cholecystectomy were randomized into two groups A (who did not receive prophylactic antibiotics) and B (those who received antibiotics). Data were recorded in a pre-designed, standardized data collection proforma and analyzed using the statistical software SPSS version 18.0. Means were calculated for continuous variables, the frequency was calculated for discrete variables and other analyses were done using the statistical software. \nResults: A total of 216 patients were included with Group A and B included 99 and 117 patients respectively with similar baseline demographic characteristics and pre-operative indications for cholecystectomy. Surgical site infection occurred in four and three patients in the study and control group respectively. All Surgical site infections were superficial and responded to conservative management only. None of the infected patients required intravenous therapy or hospitalization. The mean duration of hospital stay in patients not having received prophylactic antibiotics (Group A) approached significance (p=0.07) though the range (in days) was the same in both the groups. \nConclusions: Prophylactic antibiotics play no role in the prevention of surgical site infection in patients at high risk, undergoing laparoscopic cholecystectomy. The key to preventing postoperative infection lies in the aseptic minimally invasive operation and the necessary peritoneal lavage and drainage during LC.