Perioperative Probiotics or Synbiotics in Adults undergoing Elective Abdominal Surgery

Objective: To define the impact of perioperative treatment with probiotics or synbiotics on postoperative outcome in patients undergoing abdominal surgery. Background: Postoperative surgical infection accounts for a third of all cases of sepsis, and is a leading cause of morbidity and mortality. Probiotics, prebiotics, and synbiotics (preparations that combine probiotics and pre- biotics) are nutritional adjuncts that are emerging as novel therapeutic modalities for preventing surgical infections. However, current evidence on their effects is conflicting. Methods: A comprehensive search of the PubMed, Embase, and WHO Global Index Medicus electronic databases was performed to identify ran- domized controlled trials evaluating probiotics or synbiotics in adult patients undergoing elective colorectal, upper gastrointestinal, transplant, or hepato- pancreaticobiliary surgery. Bibliographies of studies were also searched. The primary outcome measure was incidence of postoperative infectious compli- cations. Secondary outcomes included incidence of noninfectious complica- tions, mortality, length of hospital stay, and any treatment-related adverse events. Quantitative pooling of the data was undertaken using a random effects model. Results: A total of 34 randomized controlled trials reporting on 2723 participants were included. In the intervention arm, 1354 patients received prebiotic or symbiotic preparations, whereas 1369 patients in the control arm received placebo or standard care. Perioperative administration of either probiotics or synbiotics significantly reduced the risk of infectious compli- cations following abdominal surgery. The preparations were well tolerated with no significant adverse events reported. Conclusion: Probiotics and synbiotics are safe and effective nutritional adjuncts in reducing postoperative infective complications in elective abdom- inal surgery. The treatment effects are greatest with synbiotics.