Efficacy of perioperative synbiotics treatment for the prevention of surgical site infection after laparoscopic colorectal surgery: a randomized controlled trial

• Published in: Surgery today (Tokyo, Japan) Vol. 46; no. 4; pp. 479 - 490
• Main Authors: Komatsu, Shunichiro, Sakamoto, Eiji, Norimizu, Shinji, Shingu, Yuji, Asahara, Takashi, Nomoto, Koji, Nagino, Masato
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-04-2016
• Subjects: Aged; Clostridium difficile - isolation & purification; Colon - surgery; Digestive System Surgical Procedures; Feces - chemistry; Feces - microbiology; Female; Formates - analysis; Humans; Lactic Acid - analysis; Laparoscopy; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Perioperative Care; Prospective Studies; Rectum - surgery; Succinic Acid - analysis; Surgery; Surgical Oncology; Surgical Wound Infection - prevention & control; Synbiotics - administration & dosage; Treatment Outcome; Probiotics; Colonization resistance; Postoperative complication; Bacterial antagonism; Clostridium difficile
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-015-1178-3

Purpose
The aim of this study was to assess the effect of perioperative oral administration of synbiotics on the surgical outcome in patients undergoing laparoscopic colorectal resection.
Methods
In this single-center randomized, controlled trial, patients scheduled to undergo elective laparoscopic colorectal surgery were eligible to participate and randomly assigned to a synbiotics group or a control group. The primary study outcome was the development of infectious complications, particularly surgical site infection (SSI), within 30 days of surgery.
Results
In this study, 379 patients were enrolled and randomly assigned (173 to the synbiotics group and 206 to the control group), of whom 362 patients (168 to the synbiotics group and 194 to the control group) were eligible for this study. SSI occurred in 29 (17.3 %) patients in the synbiotics group and 44 (22.7 %) patients in the control group (OR: 0.761, 95 % CI 0.50–1.16;
p
 = 0.20). Overall, the rate of postoperative complications, including anastomotic leakage, did not differ significantly between the two groups. Synbiotics treatment reversed the changes in fecal bacteria and organic acids after surgery and suppressed the increases in potentially pathogenic species, such as
Clostridium
difficile
.
Conclusion
The efficacy of perioperative administration of synbiotics was not validated as a treatment for reducing the incidence of infectious complications after laparoscopic colorectal resection. However, the microbial imbalance, in addition to the reduction in organic acids, could be improved by perioperative synbiotics treatment.