Use of probiotics in abdominal surgery

Abstract

Several clinical trials have demonstrated that the use of probiotics and synbiotics in patients undergoing abdominal surgery might be beneficial in preventing postoperative infectious complications. However, other investigators report that there is no evidence supporting any benefits from preoperative use of pre- and probiotics (synbiotics) in patients undergoing elective abdominal surgery, and that in some cases there is even an increased risk of mortality. Possible explanations behind these controversies may be found in the postoperative period of administration (median time of 4 days), the oral (instead of jejunal) route of administration with the accompanying unclear survival rate of the probiotics in the stomach due to low pH, and the high-risk operations such as complicated colectomies resulting in a high overall rate of bacterial translocation and infections. In recent years, three important randomized studies on the effects of probiotics in patients undergoing colorectal surgery have reported that the use of probiotics markedly improved intestinal microbial populations and significantly decreased the incidence of further infectious complications. Furthermore, the patients' quality of life was also improved by shortening the duration of postoperative hospital stay and the period needed for antibiotics administration. Improvements in infection-related complications and gut defecation function have also been reported in patients receiving perioperative oral probiotics treatment, suggesting that the use of probiotics could reduce the extent of damage to colon mucosa after surgery. Probiotics can improve the integrity of the gut mucosal barrier as well as the balance of the gut microbiota, and they play a role in decreasing the rate of infection. This area, however, requires more research before preoperative oral intake of probiotics combined with postoperative treatment can be recommended for patients in need of gastrointestinal surgery.