The effect of preoperative synbiotic treatment to prevent surgical-site infection in hepatic resection

Abstract

We aimed to clarify the influence of preoperative synbiotic therapy on surgical site infections (SSIs) after hepatic resection. Between January 2011 and December 2017, 284 patients who underwent hepatic resection without biliary tract reconstruction and resec tion of other organs were included. We prospectively admin istered Clostridium butyricum and partially hydrolyzed guar gum before hepatic resection between April 2016 and December 2017 (synbiotic group). One hundred fifteen patients of the synbiotic group and 169 patients (conventional group) treated between January 2011 and the end of March 2016 were compared using propensity score matching. The frequency of laparoscopic resec tion was significantly larger in the synbiotic group (conventional group; 28% vs synbiotic group; 55%, p<0.001) and the amount of intraoperative bleeding was significantly smaller in the synbiotic group (median; conventional group, 700 ml vs synbiotic group, 200 ml; p<0.001). The postoperative SSI was significantly lower in the synbiotic group of six patients (5.2%) than in the conventional group of 30 patients (17.8%) (p = 0.002). Sixty patients in each group remained after propensity score matching. There was no significant difference in the incidence of SSI between the groups (conventional group, 15% vs synbiotic group, 6.7%; p = 0.239). In conclusion, preoperative synbiotic treatment did not reduce SSIs after hepatic resection.

Effects of both Pro- and Synbiotics in Liver Surgery and Transplantation with Special Focus on the Gut–Liver Axis—A Systematic Review and Meta-Analysis

“…A total of 426 publications were excluded during abstract screening. After the elimination of case reports ( n = 2), animal studies ( n = 3) and reviews ( n = 28), 12 studies met the inclusion criteria [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] ( Figure 1 ).…”

“…In 2 studies [ 39 , 45 ], probiotics were used, while synbiotics were administered in 10 trials [ 40 , 41 , 42 , 43 , 46 , 47 , 48 , 49 ]. The most commonly utilized comparators were placebo ( n = 5) [ 39 , 40 , 41 , 45 , 47 ] and no intervention ( n = 5) [ 42 , 44 , 46 , 48 , 50 ].…”

“…To date, only 7 studies have elucidated the mechanism of how intestinal microbiota influence the course after LR. Five of them were RCTs [ 44 , 45 , 47 , 48 , 49 ], and 2 were prospective non-randomized trials ( Table 1 ) [ 46 , 50 ]. Most of the studies also focused primarily on postoperative infectious complications, which lead to increased morbidity and mortality, and also to high treatment costs.…”

“…Pro-/synbiotics were administered before and after LR in 5 of the studies, only post LR in 1 study [ 44 ], and only prior to surgery in 1 study [ 51 ]. The duration of pro-/synbiotic administration was between 1 and 14 days prior to LR, and 6 and 14 days following LR and for 1 month in the study with only preoperative administration [ 50 ]. Liu et al compared probiotic vs. placebo in their double-blind RCT in 66 vs. 68 patients undergoing LR for colorectal metastases [ 45 ].…”

“…Pre- and postoperative IL 6 levels were significantly lower, and the incidence of postoperative infectious complications was 30.0% vs. 12.1% ( p = 0.049) in the group receiving the synbiotic pre- and postoperatively. Iida et al investigated the influence of 1-month preoperative synbiotic therapy as compared with no intervention on infectious complications in 284 LR patients ( n = 115 in synbiotic group, n = 169 in control group) [ 50 ]. They found no difference regarding infection rates after LR between the groups.…”