Langenbeck's Archives of Surgery

, Volume 390, Issue 2, pp 104–113 | Cite as

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

  • Hidetoshi Kanazawa
  • Masato Nagino
  • Satoshi Kamiya
  • Shunichiro Komatsu
  • Toshihiko Mayumi
  • Kenji Takagi
  • Takashi Asahara
  • Koji Nomoto
  • Ryuichiro Tanaka
  • Yuji Nimura
Original Article


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.


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.


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%).


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.


Synbiotics Probiotics Prebiotics Infection Hepatectomy 


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Hidetoshi Kanazawa
    • 1
  • Masato Nagino
    • 1
  • Satoshi Kamiya
    • 1
  • Shunichiro Komatsu
    • 1
  • Toshihiko Mayumi
    • 2
  • Kenji Takagi
    • 3
  • Takashi Asahara
    • 4
  • Koji Nomoto
    • 4
  • Ryuichiro Tanaka
    • 4
  • Yuji Nimura
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Emergency and Critical Care MedicineNagoya University Graduate School of MedicineNagoyaJapan
  3. 3.Nagoya University College of Medical TechnologyNagoyaJapan
  4. 4.Yakult Central Institute for Microbiological ResearchTokyoJapan

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