Antibiotic Prophylaxis in Metabolic and Bariatric Surgery: A Systematic Literature Review
Abstract
Introduction: Metabolic and bariatric surgery (MBS) is the most effective treatment for obesity, yet obesity increases the risk of perioperative complications, including surgical site infections (SSIs). Although MBS are classified as clean or clean-contaminated, current guidelines recommend antibiotic prophylaxis (AP) for all such operations, despite the lack of clear clinical evidence supporting this approach. Aim: To assess the effect of AP on the incidence of surgical site infection (SSI) rate and other postoperative outcomes after metabolic and bariatric procedures. Materials and methods: A systematic search used the terms “Bariatric Surgery” and “Antibiotic Prophylaxis,” with added queries for SG, RYGB, OAGB, SADI, SASI, and AGB. Eligible designs included randomized trials and observational studies that reported clinical outcomes such as SSI, wound complications, morbidity, or mortality. Reports without original clinical data were excluded. Data were analyzed separately for clean procedures (SG, AGB) and clean-contaminated procedures (RYGB, SADI, SASI). Results: Eight studies met criteria. Only three studies directly compared AP with no prophylaxis in clean and clean- -contaminated operations and found no significant reduction in SSI rates. In clean procedures, available evidence consistently does not support routine antibiotic use. In clean-contaminated procedures, the available results were underpowered. Isolated studies suggested a modest benefit in selected…
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