SURGICAL SITE INFECTION (SSI) FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY: A SYSTEMATIC REVIEW AND A META-ANALYSIS

Anoosh Farooqui, MBBS, MD, MPH1; Arya Harikrishna, MD, MSc2; Mudasar Nisar, MBBS3; Fatima Saeed, MBBS, MD4; Nathnael Woldehana, MD, MPH5; Shree Rath, MBBS6; Michael Negussie, MD7; Juan C. Pantoja, MD8; Ishwar Basavan, MBBS9; Hamza Rafique Khan, MBBS10; Mobeen Farooqi, MBBS, MD11; Abdullah Farooqui, BS12; Jinal Choudhari, MD13; Khaled Saed, MD13; Najiha Farooqi, MD, FACS14; Mohammed Masri, MD13; 1Michigan State University; 2European University Cyprus School of Medicine; 3Services Institute of Medical Sciences; 4United Medical and Dental College; 5Myungsung Medical College Johns Hopkins University Bloomberg School of Public Health; 6All India Institute of Medical Sciences, Bhubaneswar; 7School of Medicine, College of Health Sciences, Addis Ababa University; 8Universidad del Norte; 9Jawaharlal Nehru Medical College; 10Quaid-E-Azam Medical College; 11CMH Lahore Medical College; 12Saginaw Valley State University; 13Larkin Community Hospital; 14Staten Island University Hospital

Background: Surgical site infections(SSIs) remain a significant concern in laparoscopic cholecystectomy despite its status as a minimally invasive procedure. There is a dearth of data to help shed light on the incidence and risk factors associated with SSIs. This meta-analysis quantifies SSI risk in laparoscopic cholecystectomy, evaluating incidence, prophylaxis efficacy, antibiotic use, and extraction site comparisons.

Methods: A literature search was conducted in PubMed and ScienceDirect for studies published between January,2014 and February,2024. Studies were included if they enrolled adult patients (≥18 years old) undergoing laparoscopic cholecystectomy and reported SSI rates. Data extraction included study characteristics, patient demographics, intervention details, and SSI outcomes. The risk of bias was assessed using the Revised Cochrane Collaboration’s Risk of Bias Tool(RoB-2). Meta-analysis was performed using random-effects models, and heterogeneity was evaluated with I² statistics.

Results: Thirteen studies comprising 3,659 patients were included. The SSI rate was 5.0% (95% CI:3%–8%; I²= 82%). Superficial SSI was the most common type, accounting for 67.3% of reported cases. Preoperative antibiotic prophylaxis was associated with a significantly lower SSI rate compared to control (RR 0.63, 95% CI 0.41–0.96, I²= 28%). No significant difference was found in SSI rates between epigastric and umbilical port-site gallbladder retrieval (RR 1.73, 95% CI 0.88–3.37, I²= 0%).

Conclusions: Laparoscopic cholecystectomy is associated with a relatively low overall SSI rate. Preoperative antibiotic prophylaxis appears to reduce this risk further. The choice of port site for gallbladder retrieval does not significantly impact SSI rates. These findings can inform clinical practice and guide future research in minimizing SSI risk in laparoscopic cholecystectomy.