Perioperative prebiotics, probiotics or synbiotics for elective abdominal surgery in adults

Chowdhury, Abeed H.; Varadhan, Krishna K.; Lobo, Dileep N.

doi:10.1002/14651858.cd009246

Cited by 2 publications

(3 citation statements)

References 39 publications

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“…In particular, some perplexity has arisen because the beneficial effect of probiotics was not consistent in all patients [153]. Recently, many comprehensive systematic reviews and/or meta-analyses have investigated the association between the administration of probiotics and synbiotics and abdominal surgery outcomes [154][155][156]. These systematic reviews and/or meta-analyses found only a few studies that targeted the sole use of prebiotic; therefore, they focused on probiotics and synbiotics, including 34 RCTs, in their analysis.…”

Section: The Role Of Probiotics and Synbioticsmentioning

confidence: 99%

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

et al. 2021

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Background The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the “missing factor” that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery. Methods We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics. Results According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection. Conclusions The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations.

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Section: The Role Of Probiotics and Synbioticsmentioning

confidence: 99%

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

et al. 2021

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“…Based on the Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (section 3.2.4.1), the measurement of certain outcomes in a study may be an eligibility criterion; especially when the review addresses the potential for an intervention (probiotics or synbiotics) to prevent a particular outcome (infectious complications). 2 In accordance with this rationale, studies that used the intervention (probiotics or synbiotics) for purposes other than preventing infectious complications and, therefore, did not record infectious complications were ineligible.…”

Section: Response To Thementioning

confidence: 99%

“…First, we reviewed the Inclusion and Exclusion Criteria of this study, 1 and the previously published Cochrane Protocol 2 as well, neither of them indicated that studies would be excluded if they did not report infectious complications. Therefore, it is questionable, why eleven studies were excluded as they did not report infectious complications but possibly reported secondary outcomes.…”

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confidence: 99%

Comment on “Perioperative Probiotics or Synbiotics in Adults Undergoing Elective Abdominal Surgery

Wu¹,

Wu²,

Liu

et al. 2019

Annals of Surgery

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Notably, as strengthened repeatedly in the original report, 1 findings from observational studies can only suggest associations, but cannot infer causality before being further supported by prospective and/or randomized studies. Furthermore, the underlying report 1 suggested quality metrics for lymph node examination to address stage migration and stratify patient survival at the population level, and the management of each individual case should be personalized: that is, while overall examining more lymph nodes was numerically associated with higher survival, not every PaC case necessarily benefited from examination of lymph nodes more than the determined thresholds. For clinical decisionmaking, models that can predict individualized benefits and harms from dissecting a certain number of lymph nodes may be needed in this regard. Also as highlighted in the original report, 1 the number of ELNs results from the joint efforts of both surgeons and pathologists. Based on meticulous and thorough lymph node examination, the correspondence between the number of ELNs and the extent of lymphadenectomy should be carefully determined. I would strongly agree that surgical safety, which is a very important issue in major surgery especially pancreatectomy and which can greatly impact patient survival, should always be taken into account when planning treatment for patients with PaC, and benefits and harms should be always carefully weighted when considering a specific treatment modality.

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Perioperative prebiotics, probiotics or synbiotics for elective abdominal surgery in adults

Cited by 2 publications

References 39 publications

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

Comment on “Perioperative Probiotics or Synbiotics in Adults Undergoing Elective Abdominal Surgery

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