Single Dose vs Multiple Dose Prophylactic Antibiotic to Prevent Early Port-Site Infection in Elective Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment of symptomatic cholelithiasis. The need of the hour is to understand the fact that PSI is a totally different subset of infection and antibiotics are not a solution to this problem. The core issue of “prevention” is the principal solution. The study was undertaken to revalidate these well known facts with an effort to bring about a radical reform to this “social” rather than clinical problem. Material and Methods: The study comprised of 60 patients admitted for elective LC. The first thirty patients undergoing elective LC were given single dose (SD) ciprofloxacin (500 mg) within an hour between the induction and making of the first port. While the control group received ciprofloxacin (500mg) post-operatively in the ward from ward nurses (MD). Operation-room anesthetic assistant administered prophylactic antibiotics at induction of anaesthesia to all the patients. Results: Of the 30 cases that received single dose prophylactic antibiotic pre-operatively, 16.67% were males and 83.3% were females. And, of the 30 cases that received multiple dose prophylactic antibiotic pre as well as post-operatively, 10% were males and 90% were females. Analysis showed that there was no statistically significant difference across the groups in regard to the duration of preoperative hospital stay. Of the 30 cases that received single dose prophylactic antibiotic preoperatively, only one patient suffered gross contamination during the surgery. Conclusion: The rate of early PSI after administration of single dose ciprofloxacin (500 mg) intravenously at induction of anesthesia and multiple dose ciprofloxacin (500 mg given thrice or four times) intravenously post-operatively for two or three days in addition to peri-operative dose is comparable in elective laparoscopic cholecystectomy. Furthermore, hospital cost can be reduced with single dose antibiotic regimen. So single dose of ciprofloxacin 500 mg can be used safely in elective cases of laparoscopic cholecystectomy to avoid infection at port site.

Frequency of Port Site Infection in Laparoscopic Cholecystectomies: An Hospital Based Study

Background: Port site infection (PSI), although infrequent, isone of the bothersome complications which undermine thebenefits of minimal invasive surgery. The aim of this study toevaluated the frequency of Port Site infections (PSI) inlaparoscopic cholecystectomies.Materials & Methods: This is a hospital based observationalstudy done on 20 cases with port site infection afterlaparoscopic cholecystectomy in the department of GeneralSurgery, Government Medical College, Pali. Wounds wereassessed clinically a week after surgery and in case infectionhad occurred; once weekly until 4 weeks in the out-patientsclinic. The frequency of port site infection studied in relationextent of infection, duration of surgery, intra-operative findings,site of port that was infected.Results: The mean age of patients was 43.26 years.According to the site of port infection, 19 patients (95%)developed an infection at the epigastric port and one patient(5%) developed an infection at the umbilical port, which was Pvalue was >0.05. The mean duration of surgery was 63.5minutes. The port site infection was present in 18 (90%)patients at 7 days and only 1 (5%) case had port site infectionat 30 days in our study.Conclusion: Laparoscopic cholecystectomy is associated witha low risk of port-site infection which in most the cases is onlysuperficial responding to local measures. Complication canoccur even in the best of hands and it is vital that these arerecognized properly and immediately addressed.

Port Site Infection in Laparoscopic Surgeries.

Background/Aims: As the surgeries undertaken by laparoscope are increasing, complications are also increasing. In light of the explosive increase in laparoscopic surgery, there is concern about the effectiveness of sterilizing reusable laparoscopic instruments which might be a potential source of infection if not properly sterilized. Our study explains port site infection, its diagnosis and management with review of literature. Setting and Design: This study was carried out in a tertiary care setting and was an outcome study. Material and Methods: All five patients in the study were operated (April 2008-2010) elsewhere and came to us for management of non healing sinuses. Result: Amongst operated cases of laparoscopic cholecystectomy one healed by irrigation with superoxide, two cases healed with sinus exploration and wound debridement while one case required extensive wound debridement requiring temporary mesh repair of the abdominal wall with removal of the mesh (due to persistence of sinus) six months later following complete healing, no residual hernia. One operated case of laparoscopic incisional hernia repair with laparoscopic Cholecystectomy healed after removal of mesh with sinus exploration. Conclusion: The present study is an attempt to make surgeons aware about the complications which occur due to improper sterilisation of laparoscopic instruments ending into increased morbidity of patients.