Bile Culture during Laparoscopic Cholecystectomy

ABSTRACT

BACKGROUND: Laparoscopic cholecystectomy has substituted open cholecystectomy for cholelithiasis during the last decades. In the past, biliary surgeons have performed the intraoperative bile culture during open cholecystectomy and have used the culture results as a guideline of postoperative antibiotic therapy. The prophylactic antibiotic treatment for cholecystectomy have been needed in the elderly population and the high risk patients, but the effect of antibiotics in laparoscopic cholecystectomy has not been confirmed. The authors performed bile culture during laparoscopic cholecystectomies to evaluate the relationship between the bile culture results and the postoperative infectious complications. METHODS: We analyzed the 57 patients who had undergone laparoscopic cholecystectomy, 53 for cholelithiasis, 4 for gallbladder polyp and an intraoperative bile culture for 6 months period. RESULTS: Positive culture results were found in 12 cholelithiasis patients (22.6%). The most common pathogen was E.coli (8.8%), enterococcus (7.0%); others were Pseudomonas, Strenotrophomonas maltophilia, Klebsiela, ect. The results of the bile culture in 4 patients with gallbladder polyps were negative. Nine patients had severe inflammation of gallbladder and four of them had positive culture results. Risk factors, such as old age and hyperbilirubinemia were significant variables. CONCLUSIONS: Intraoperative bile culture is an easy and simple procedure in a laparoscopic cholecystectomy and offers much informations to the surgeon about biliary bacteriology and postoperative management. The rate of wound infection is very low in laparoscopic cholecystectomy and the necessity of prophylactic antibiotics in laparoscopic cholecystectomy is less than it is in open surgery. Prophylactic antibiotics during laparoscopic cholecystectomy should be reserved for only high-risk patients.