A COMPARATIVE STUDY TO ASSESS THE ROLE OF PROPHYLACTIC ANTIBIOTICS IN ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

Benign biliary tract diseases are one of the most common surgical problems in the world. Cholelithiasis is rare in the first two decades of life. Incidence gradually increases after 21 years and reaches peak in 5th and 6th decade women are more commonly affected than men in the ratio of 4:1.(1) The advent of laparoscopic surgery ushered in a new era in general surgery in the management of symptomatic gall stones. Open cholecystectomy is associated with a higher wound infection rate ranging from 1-21%. The use of prophylactic antibiotics reduced this rate to 3%-7% and so has become common practice. Laparoscopic cholecystectomy is associated with smaller wounds and minimal tissue damage and therefore presumably a lower risk of wound infection. METHODOLOGY A prospective randomized control study involving a sample size of 52 patients (26 in the study group + 26 in the control group) was conducted over a period of 2 years. Chi square test of significance was used to test the difference in the proportion between the groups. To test whether there is significant difference in the means of 2 groups; Independent t-test/Mann Whitney test will be used. Statistical analysis was done using IBM SPSS 20 statistical software. RESULTS The mean age in the study group was 43 years and the mean age in the control group was 44.42. Samples are age matched with P=0.421, Student 't' test. Incidence of Gallbladder disease was more in females in both the study group and the control group. Samples are gender matched with P=0.768. No SSI noted in the control group. 1 patient [3.8%] had SSI in the study group=1.000, Not significant, Fisher Exact test. E. coli was the organism isolated in the patient with SSI. P=1.000, Not significant, Fisher Exact test. Incidence of bile spillage was 7.7% in both the control group and the study group=1.000, Not significant, Fisher Exact test. DISCUSSION The use of prophylactic antibiotics in open cholecystectomy to reduce the rate of postoperative infective complications is considered to be the standard of practice. However, its use in laparoscopic cholecystectomy has been an area of conflicting opinion. CONCLUSION In conclusion, the results of this study have shown that avoiding prophylactic antibiotics in patients undergoing elective laparoscopic cholecystectomy increases the incidence of postoperative infective complication but not to a statistically significant degree.