Laparoscopic Cholecystectomy in a Resource-Constrained Hospital in South Africa: Antibiotic Prophylaxis, Iatrogenic Perforation, Risk Factors, and Management

Introduction Iatrogenic gallbladder perforation is a notable complication of laparoscopic cholecystectomy. Despite its prevalence, optimal antibiotic prophylaxis strategies remain controversial. This study examines the use of antibiotics during laparoscopic cholecystectomy, evaluates the management of gallbladder perforations, and identifies associated risk factors. Method A retrospective analysis of 152 laparoscopic cholecystectomy patients at New Somerset Hospital was conducted, covering April 2021 to June 2023. Data collection included demographics, comorbidities, surgical indications, imaging findings, antibiotic regimens, and intraoperative and postoperative management of gallbladder perforations. Histological outcomes and complication management were also reviewed. Results Among the 152 patients, 86.85% (n=132) were female. Gallbladder perforation occurred in 55.9% (n=85). Spillage findings varied: bile alone (n=59), bile with stones (n=19), stones alone (n=3), pus (n=1), and stone with pus (n=1). Two patients had no spillage after iatrogenic perforation. Intraoperative management universally involved suction and lavage. Sixteen antibiotic protocols were documented, with 140 patients receiving preoperative, intraoperative, postoperative antibiotics, or combinations thereof. No infectious complications were reported. Age over 40 (65.2%, n=92) was a significant risk factor for perforation (p<0.05). Conclusion This study recommends a single preoperative dose of cefazolin to prevent infectious complications, even in cases of gallbladder perforation. Suction, washout, and retrieval of spilled stones are essential for managing perforations effectively. Establishing standardized antibiotic protocols could improve outcomes and reduce variability in clinical practice.