Cholecystectomy and antibiotic prophylaxis in patients at low-medium anesthetic and infectious risk.

Introduction. In video laparoscopic cholecystectomy technique (VLS), cephalosporins are the antibiotics most widely used in the prophylaxis of infections. Aim. Evaluation of the effect of antibiotic prophylaxis on the incidence of infection and prognosis in patients at low-medium anesthetic and infectious risk underwent VLS cholecystectomy for benign disease (lithiasis, polyps). Materials and methods. We studied 75 patients (26 M, 49 F, mean age 45 years) suffering from lithiasis (66 pt) and polypoid lesions (9 pt) of the gallbladder, divided randomly into 3 groups. The patients were at low-medium anesthetic risk (ASA I-III) and infectious (diabetes mellitus, kidney disease, COPD, congenital heart disease, previous malignancy). At the induction of anesthesia groups A (24 pt) and B (24 pt) received, respectively, sulbactam / ampicillin 3 g and ciprofloxacin 400 mg single dose intravenous infusion. In group C was not administered antibiotics. In all cases was performed cultural examination of bile from the gallbladder taken at the end of the intervention. We evaluated: incidence of infections, circulating leukocytes, body temperature, pain, intestinal peristalsis, days of hospitalization, cosmetic damage and histological examination. Results. Infectious complications on-site umbilical fascial were 2 (8.3% ) in group A and 4 (14.8%) in group C. Infections have not been registered in the group B, without any statistical significant differences between the 3 groups. In the first day after surgery the value of circulating leukocytes was > 10x10/UL in 16/24 patients (66.6%) in group A, in 14/24 patients (58.3%) in group B, in 7/27pz (25.5 %) in group C (p = 0.016). The outcome occurred in II dayafter surgery in 8/24 patients (33.3%) in group A, in 9/24 patients (37.5%) in group B, in 11/27 patients (40.7%) in group C. In III days the outcome occurred in 14 patients of the group A, in 14 patients of the group B, in 14 patients of group C. The remaining patients were discharged on day IV after surgery, also in this case without any statistical significant differences between the 3 groups. Discussion. the infections observed were limited only to the peri-umbilical site, never associated with fever and neutrophilic leukocytosis, with delayed intestinal duct, prolongation of the hospitalization, cosmetic damage, increased costs. The infectious complication did not correlate statistically significantly with BMI, duration of anesthesia, the surgical and histological examination. In all patients, the bile culture was sterile, then the infection of the umbilical site is not due to bacterial infection from the gallbladder. It is possible that ischemia by repeated surgical trauma of skin margins of the site promotes contamination by pathogenic bacteria from the skin with not accurate antisepsis in pre-operative phase. Conclusions. Antibiotic prophylaxis with sulbactam/ampicillin or ciprofloxacin did not affect the prognosis. There were no major differences in infectious complications statistically significant between the 3 groups. Therefore, antibiotic prophylaxis with cephalosporins, beta-lactamine, fluoroquinolones in the VLS cholecystectomy for benign disease, in patients with low-medium anesthetic risk and chronic diseases not seem to improve the infections or the outcome of the patients.