Clinical Report: Antibiotic Prophylaxis in Laparoscopic Adnexal Surgery
Overview
This multicenter retrospective cohort study was designed to compare 30-day surgical site infection (SSI) incidence after benign laparoscopic adnexal surgery in patients who received pre-incision cefazolin and those who received no prophylactic antibiotics. It also assessed perioperative factors potentially associated with SSI. The supplied article text does not include study results, so comparative infection rates and associated factors cannot be reported.
Background
Laparoscopic adnexal procedures are commonly used for benign gynecologic conditions and, compared with laparotomy, are associated with less postoperative pain, shorter hospitalization, and faster recovery. Whether clean laparoscopic procedures require routine antibiotic prophylaxis remains disputed: Japanese guidance cited in the article recommends cefazolin, whereas ACOG and SOGC guidance cited there advises against routine prophylaxis when the gastrointestinal or genitourinary tract is not entered. The article notes that unnecessary antibiotic exposure raises antimicrobial-stewardship concerns, including resistance, allergic reactions, and microbiome disruption. Patient and procedural characteristics—including obesity, diabetes, smoking, immunocompromised status, operative time, surgical approach, and device use—are identified as potential considerations in SSI risk assessment.
Data Highlights
Study feature
Details reported
Design and setting
Multicenter retrospective cohort using a prospectively maintained perioperative database at Osaka University and six affiliated Japanese hospitals
Study period
January 2020 through December 2023
Population
Consecutive patients undergoing laparoscopic adnexal surgery for benign indications
Exposure comparison
Pre-incision cefazolin (CEZ group) versus no prophylactic antibiotics
Primary outcome
SSI within 30 days, categorized as superficial incisional, deep incisional, or organ/space pelvic infection using CDC criteria
Secondary assessment
Associations with age, BMI, diabetes, endometriosis, prior abdominal surgery, uterine manipulator use, operative time, and blood loss
Results available in supplied text
Not reported; the provided material ends during the statistical-analysis section
Key Findings
The study included eligible benign laparoscopic adnexal procedures performed at seven Japanese hospitals over four years; the supplied text does not state the number of participants.
Six hospitals routinely administered intravenous cefazolin 1–2 g within 60 minutes before incision, while one hospital did not routinely administer prophylaxis.
Patients were excluded for adnexal abscess or pelvic inflammatory disease, conversion to laparotomy, specified non-abdominal tissue retrieval incisions, concurrent hysteroscopy, or prophylaxis other than cefazolin.
The primary endpoint was 30-day SSI, classified by CDC criteria into superficial incisional, deep incisional, or organ/space pelvic infection.
The article describes differing guidance: Japanese Society of Chemotherapy guidance recommends cefazolin, while ACOG and SOGC guidance cited in the article advises against routine prophylaxis for class I clean laparoscopic procedures without gastrointestinal or genitourinary tract entry.
The supplied related-article context reports that a pilot randomized trial in benign non-hysterectomy gynecologic laparoscopy found very low event rates and no clear prophylactic-antibiotic benefit; it also describes a 2024 randomized study of 100 women as finding no significant difference in postoperative infectious outcomes. These are separate studies, not results of the cohort reported here.
Clinical Implications
The supplied material establishes that prophylaxis policies differ and that this cohort was designed to examine SSI incidence and perioperative risk factors, but it does not provide the cohort's results. Accordingly, no study-specific conclusion about cefazolin effectiveness or risk-based selection can be drawn from the provided text.
Conclusion
The article describes a multicenter cohort addressing an unresolved question about routine cefazolin prophylaxis in benign laparoscopic adnexal surgery. Because the supplied report omits the results, its objectives and methods can be summarized, but its findings cannot be determined.
