Chauhan Vikram Singh, Kariholu P L, Saha Sabyasachi, Singh Himanshu, Ray Jasmine
Department of Surgery, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India.
J Minim Access Surg. 2018 Jul-Sep;14(3):192-196. doi: 10.4103/jmas.JMAS_95_17.
: Elective laparoscopic cholecystectomy (LC) has low risk for post-operative infectious complications; still most clinicians use persistent post-operative prophylactic antibiotics out of habit, tradition, or simply as defensive practice due to evolving medicolegal implications of a large number of surgeries being showcased as daycare or next day discharge procedures. This randomised prospective trial was done to test the need for such prophylaxis in cases of elective LC in a rural/semi-urban setting.
: Two hundred and ten successive patients undergoing elective LC were randomised into groups receiving single dose of injection ceftriaxone at the time of induction of anaesthesia, (Group A = 112 cases) and those who in addition to above received injection ceftriaxone twice daily for 2 days postoperatively (Group B = 98 cases). Post-operative infectious complications between two groups were compared for variables such as age, sex, body mass index and bile/stone spillage.
: There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, American Society of Anesthesiologists grade, duration of surgery and hospital stay. Intraoperative spillage of stones (9.8% [A]: 5.1% [B]) did not increase infectious complications even in the presence of positive bile culture (Group A, N = 7 vs. Group B, N = 3). An operative time of greater than 60 min was found to be associated with increased surgical site infection (P = 0. 0006).
: Single dose of ceftriaxone at the time of induction is adequate prophylaxis following elective LC even in the rural/semi-urban Indian setting and routine continued administration of antibiotic should be abandoned as it contributes to adverse reactions, drug resistance and unnecessary financial burden.
择期腹腔镜胆囊切除术（LC）术后感染并发症风险较低；然而，由于大量手术被宣传为日间手术或次日出院程序，医疗法律问题不断演变，大多数临床医生出于习惯、传统或仅仅作为一种防御性做法，仍会在术后持续使用预防性抗生素。本随机前瞻性试验旨在测试在农村/半城市环境中进行择期LC时是否需要这种预防措施。
210例连续接受择期LC的患者被随机分为两组，一组在麻醉诱导时接受单剂量头孢曲松注射（A组 = 112例），另一组除上述治疗外，术后还每日两次接受头孢曲松注射，共2天（B组 = 98例）。比较两组术后感染并发症的年龄、性别、体重指数和胆汁/结石溢出等变量。
两组在年龄、性别、体重指数、症状持续时间、美国麻醉医师协会分级、手术持续时间和住院时间等变量方面，手术部位感染率无显著差异。即使胆汁培养呈阳性，结石术中溢出（9.8% [A组]：5.1% [B组]）也未增加感染并发症（A组，N = 7 vs. B组，N = 3）。发现手术时间大于60分钟与手术部位感染增加有关（P = 0.0006）。
即使在印度农村/半城市环境中，择期LC后在麻醉诱导时给予单剂量头孢曲松作为预防措施就足够了，应放弃常规持续使用抗生素，因为这会导致不良反应、耐药性和不必要的经济负担。
