An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials on Postoperative Antibiotic Administration After Cholecystectomy for Acute Mild to Moderate Cholecystitis

The role of extended postoperative antibiotic therapy after cholecystectomy for mild-to-moderate acute cholecystitis remains controversial. This systematic review and meta-analysis aimed to update the existing evidence by incorporating more recently published randomized controlled trials to evaluate whether postoperative antibiotics reduce infectious complications in this patient population. A systematic search identified randomized controlled trials comparing postoperative antibiotics versus no postoperative antibiotics following cholecystectomy for mild-to-moderate acute cholecystitis. All included patients received standard pre- or perioperative antibiotic prophylaxis. Primary outcomes were overall surgical site infection, superficial infection, deep wound infection, and organ space infection. Secondary outcomes included postoperative hospital stay, fever lasting more than two days, morbidity, and urinary tract infection. Five randomized controlled trials involving 931 patients were included, of whom 449 (48.2%) received postoperative antibiotics. Postoperative antibiotics did not significantly reduce overall surgical site infection rates or superficial and deep wound infections. A significant reduction in organ space infection was observed. No significant differences were found in postoperative hospital stay, postoperative fever, morbidity, or urinary tract infection. Routine postoperative antibiotic administration after cholecystectomy for mild-to-moderate acute cholecystitis does not provide a significant benefit in reducing overall surgical site infections or other postoperative outcomes, apart from a limited reduction in organ space infections. When adequate source control is achieved with appropriate pre- or perioperative prophylaxis, a selective and patient-specific approach to postoperative antibiotic use is supported to minimize unnecessary antibiotic exposure and promote antimicrobial stewardship.