Original Article

Langenbeck's Archives of Surgery

, Volume 390, Issue 2, pp 104-113

First online:

Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy

  • Hidetoshi KanazawaAffiliated withDivision of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • , Masato NaginoAffiliated withDivision of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • , Satoshi KamiyaAffiliated withDivision of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • , Shunichiro KomatsuAffiliated withDivision of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • , Toshihiko MayumiAffiliated withDepartment of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine
  • , Kenji TakagiAffiliated withNagoya University College of Medical Technology
  • , Takashi AsaharaAffiliated withYakult Central Institute for Microbiological Research
  • , Koji NomotoAffiliated withYakult Central Institute for Microbiological Research
  • , Ryuichiro TanakaAffiliated withYakult Central Institute for Microbiological Research
    • , Yuji NimuraAffiliated withDivision of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine Email author 

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Abstract

Background and aims

The clinical value of synbiotics in surgical patients remains unclear. The aim of this study was to investigate the effect of synbiotics on intestinal integrity and microflora, as well as on surgical outcome, in patients undergoing high-risk hepatectomy.

Methods

Fifty-four patients with biliary cancer were randomly allocated to two groups before hepatectomy. One group received postoperative enteral feeding that included synbiotics; the other received enteral feeding only. Lactulose/mannitol (L/M) ratio, serum diamine oxidase (DAO) activity, and fecal microflora and organic acid concentrations were determined. Postoperative infectious complications were recorded.

Results

Of the 54 patients, 44 completed the trial (21 receiving synbiotics and 23 others as controls). Postoperative changes in L/M ratios and serum DAO activities were identical between the two groups. Numbers of beneficial bacteria increased in the synbiotics group after surgery but decreased in controls. Numbers of harmful microorganisms decreased in the synbiotics group but increased in controls. Total organic acid concentrations increased in the synbiotics group but decreased in controls. Incidence of infectious complications was 19% (4/21) in the synbiotics group and 52% (12/23) in controls (P<0.05). All study patients tolerated surgery (mortality 0%).

Conclusions

Synbiotics, combined with early enteral nutrition, can reduce postoperative infections. This beneficial effect presumably involves correction of an intestinal microbial imbalance induced by surgical stress.

Keywords

Synbiotics Probiotics Prebiotics Infection Hepatectomy