S. Arumugam1, K. Mahendraraj1, R. S. Chamberlain1 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA
Introduction: The gastrointestinal (GI) tract is intimately linked to the development of systemic anti-inflammatory response and sepsis following surgery. GI surgery significantly disrupts the natural microbiome environment by altering nutrient metabolism and deregulating immune function. The health benefits of probiotics and synbiotics is well established in healthy adults, but their role in preventing postoperative complications including sepsis remains controversial. This meta-analysis assesses the impact of probiotics and synbiotic preparations on the incidence of postoperative sepsis in GI surgical patients.
Methods: A comprehensive search of Pub Med, Google Scholar, and Cochrane Review (1966-2014) was performed seeking all published randomized controlled clinical trials (RCTs) assessing the impact of perioperative probiotics or synbiotics in elective GI surgery. Studies were included if patients underwent GI surgery with the addition of adjunct prebiotic, probiotic, or a synbiotic therapy and a control group receiving placebo or no therapy.16 potentially eligible studies were identified, of which 4 were excluded for lack of randomization, inadequate blinding and incomplete outcome data. Only RCTs which were completed and analyzed as level 1 studies were included. The primary outcome measured was postoperative sepsis within 1 month of surgery.
Results:12 RCTs involving 815 patients were included. 327 patients received synbiotics and 83 received probiotics, while 405 patients received placebo or no therapy. Overall, there was a 41% reduction in postoperative sepsis for patients treated with either a synbiotic or probiotic compared to the control group (RR 0.59; 95% CI=0.45-0.77; p<0.001). When assessing specific treatment, there was 76% reduction in the incidence of postoperative sepsis in the probiotic group (RR-0.24 ;95% CI=0.12-0.50; p <0.001) and a 32% reduction in sepsis in the synbiotic group compared to the control group. (RR-0.68; 95% CI, 0.51-0.92 p = 0.014).
Conclusion:
Perioperative probiotic and synbiotic therapy significantly reduces the likelihood of post-operative sepsis in elective GI surgical patients. The adoption of this strategy is encouraged to optimize gut microbiota modulation after elective GI surgery. Additional studies are required to optimize duration, dose, and types of pro- and prebiotic regimens which yield the greatest benefit.
