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Role of prophylactic antibiotics in elective laparoscopic 
cholecystectomy: A systematic review and meta-analysis 

Ann Hepatobiliary Pancreat Surg 2018 Aug;22(3):231-47
Published online August 31, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Sang Hoon Kim, Hee Chul Yu, Jae Do Yang, Sung Woo Ahn, Hong Pil Hwang

Department of Surgery, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk University Hospital, and Research Institute for Endocrine Sciences, Chonbuk National University, Jeonju, Korea
Received June 20, 2018; Revised June 29, 2018; Accepted July 31, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords : Laparoscopic cholecystectomy; Antibiotic prophylaxis; Meta-analysis


August 2018, 22 (3)