Laparoscopic Cholecystectomy without Prophylactic Antibiotics in Low-Risk Patients: A Comparative Prospective Study

Abstract

Background: Elective laparoscopic cholecystectomy is a clean surgical procedure with a very low risk of surgical site infection. Despite this, prophylactic antibiotics are still routinely administered in many centres, leading to unnecessary antibiotic exposure. Rational antibiotic use is essential to reduce adverse drug reactions, limit antimicrobial resistance, and promote evidence-based surgical practice. Objectives: This study aimed to evaluate the need for antibiotic prophylaxis in low-risk patients undergoing elective laparoscopic cholecystectomy by comparing surgical site infection rates and postoperative outcomes, including wound healing, duration of hospital stay, and need for postoperative antibiotic administration in patients who received prophylactic antibiotics and in those who did not receive; and to support antimicrobial stewardship. Methods: This prospective, non-randomized comparative study included 100 patients aged 21 to 65 years who underwent elective laparoscopic cholecystectomy. Patients were divided into two equal groups. Group A did not receive prophylactic antibiotics, whereas Group B received intravenous cefuroxime (1.5 g) 10 to 60 minutes before incision. Demographic details, body mass index, operative duration, and length of hospital stay were recorded. The surgical site was assessed by the treating surgical team according to the CDC guidelines at 48 hours, 1 week, 30 days, and 90 days. Results: Baseline characteristics were comparable between the two groups. Operative time and hospital stay were slightly longer in Group A, but the differences were not significant. No surgical site infection occurred in Group A during 90 days of follow-up. One patient in Group B developed a superficial surgical site infection that resolved with conservative management. No deep or organ-space infections and no mortality were observed. Conclusions: Omission of prophylactic antibiotics did not increase postoperative infection rates in low-risk patients undergoing elective laparoscopic cholecystectomy. Routine antibiotic prophylaxis is unnecessary in such patients and should be reserved for high-risk situations to support rational antibiotic use.

Keywords: Laparoscopic cholecystectomy, Antibiotic prophylaxis, Surgical site infection, Antimicrobial stewardship