Surgical infections after laparoscopic cholecystectomy: ceftriaxone vs ceftazidime antibiotic prophylaxis. A prospective study.

The incidence of surgical infections after laparoscopic cholecystectomy is reported to be <2%, because of the minimal trauma due to this approach. We report the results of a prospective study of antibiotic prophylaxis in laparoscopic cholecystectomy, comparing ceftriaxone vs ceftazidime. From Jan 1 to Dec 31 2002 a consecutive series of 242 cholecystectomies were performed, consisting in 18 open cholecystectomies and 224 laparoscopic cholecystectomies, 7 of which (3.1%) were converted to open cholecystectomies for technical and/or anatomical reasons. One hundred and eleven patients received 1 g i.v. ceftazidime 1 h before surgery, and 105 patients 1 g i.v. ceftriaxone on an alternate basis. Thirty-nine patients (17.4%) with acute cholecystitis received at least one booster dose at the end of the operation; 30 out of 39 were given further therapy for 2-3 days, i.e. 1 g i.v. bid. Twenty-two patients treated elsewhere with ceftriaxone or ceftazidime before surgery were transferred to another prophylactic regimen. The final diagnosis in the laparoscopic cholecystectomy group was 219 bile stones, 3 adenomas, and 2 occult carcinomas. We had 4 complications (1.8% of 217 laparoscopic cholecystectomies), 2 of which were minor (infection of the umbilical access by S. aureus) and 2 major (1 biliary fistula [accessory duct] and 1 acute pancreatitis), both treated conservatively. Positive bile cultures (27 cases) were unrelated to the clinical course. The incidence of infections after laparoscopic cholecystectomy in our prospective series was <2%. Ceftriaxone is confirmed as the gold standard in biliary tract surgery, but ceftazidime was equivalent (no statistical difference between the two antibiotics, P=0.59 NS). Ultra-short prophylaxis is enough in most cases, except in cholecystitis. We found no correlation between positive bile cultures and surgical infections after laparoscopic cholecystectomy. The umbilicus was the preferred site of infection in obese patients after the laparoscopic procedure. Major complications are usually related to technical pitfalls.