Pavlidis ET, Galanis IN, Pavlidis TE. Current opinions on the use of prophylactic antibiotics in patients undergoing laparoscopic cholecystectomy. World J Gastrointest Surg 2025; 17(3): 101938 [DOI: 10.4240/wjgs.v17.i3.101938]
Corresponding Author of This Article
Theodoros E Pavlidis, PhD, Doctor, Emeritus Professor, Surgeon, The Second Department of Propaedeutic Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 54642, Greece. pavlidth@auth.gr
Research Domain of This Article
Surgery
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Mar 27, 2025; 17(3): 101938 Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.101938
Current opinions on the use of prophylactic antibiotics in patients undergoing laparoscopic cholecystectomy
Efstathios T Pavlidis, Ioannis N Galanis, Theodoros E Pavlidis
Efstathios T Pavlidis, Ioannis N Galanis, Theodoros E Pavlidis, The Second Department of Propaedeutic Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Author contributions: Pavlidis TE designed research, contributed new analytic tools, analyzed data, review and approved the paper; Galanis IN analyzed data, review and approved the paper; Pavlidis ET performed research, analyzed data, review and wrote the article.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Theodoros E Pavlidis, PhD, Doctor, Emeritus Professor, Surgeon, The Second Department of Propaedeutic Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 54642, Greece. pavlidth@auth.gr
Received: October 2, 2024 Revised: January 17, 2025 Accepted: January 23, 2025 Published online: March 27, 2025 Processing time: 145 Days and 0.1 Hours
Abstract
Inappropriate use of antibiotics leads to microbial resistance. Single-dose antibiotic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk patients despite some conflicting aspects. High-risk patients are those who are older than 70 years, have diabetes mellitus, whose operation time exceeded 120 minutes, have acute cholecystitis, experienced iatrogenic intraoperative gallbladder perforation resulting in bile or gallstone spillage, suffered from obstructive jaundice, or were deemed immunocompromised. For gallbladder perforation, one dose of antibiotic prophylaxis is sufficient. Therefore, guidelines are needed and must be strictly followed. Prophylactic treatment is not needed for patients at low risk of developing sepsis following elective laparoscopic cholecystectomy, although the opposite is supported. Similarly, superficial surgical infections are related to low morbidity. Patients without risk factors have a very low risk of infection. Thus, the routine use of antibiotic prophylaxis in elective laparoscopic cholecystectomy is not recommended.
Core Tip: In the most cases of elective laparoscopic cholecystectomy, there is a low possibility of septic complication development and no need for prophylactic antibiotics. In few patients with some well-defined risk factors for infection, including acute cholecystitis, the antibiotic prophylaxis before skin incision is necessary to minimize such complications.
