Does probiotic application improve clinical outcomes in colorectal surgery?

Czech version

Authors: J. Kotoč ¹; K. Kotočová ¹; J. Gatěk ^1,2; B. Dudešek ^1,2; J. Duben ^1,2; P. Ponížil ³
Authors‘ workplace: Chirurgické oddělení Nemocnice Atlas a. s., Zlín ¹; Institut zdravotnických studií, Fakulta humanitních studií, Univerzita T. Bati ve Zlíně ²; Ústav fyziky a materiálového inženýrství, Technologická fakulta, Univerzita T. Bati ve Zlíně ³
Published in: Gastroent Hepatol 2014; 68(1): 43-47
Category: Clinical and Experimental Gastroenterology: Original Article

Overview

Aim:
To evaluate the effects of pre-operative administration of type-specific probiotics in colorectal surgery on the rate of post-operative (especially infection-related) complications; on the period of antibiotic administration; and on the speed of restoration of gut motility and length of hospital stay.

Methods:
Patients undergoing elective colon or rectal resection with anastomosis from June 2011 to April 2013 were in turns randomly divided into the probiotics group (22 patients) and the control group (23 patients). Patients with probiotics received (twice daily, 10 days before surgery) enterosolvent capsules consisting of 6 × 10⁹ of five different freeze-dried Lactobacilli and Bifidobacteria species (L. rhamnosus 55%, B. breve 20%, L. casei 15%, L. acidophilus 5%, B. longum 5%). Postoperatively, the inflammatory complications, duration of antibiotic treatment, speed of restoration of intestinal peristalsis in patients and length of hospital stay were evaluated.

Results:
The interval to first peristalsis was significantly shorter in the probiotics group compared with the control group (1.5 days vs 2.0 days; p = 0.01). The decrease in infection-related complications (surgical wound infection, pneumonia) in the probiotics group was not statistically significant. The shorter antibiotic administration period in the probiotics group was statistically significant at the significance level p = 0.089. The length of hospital stay in patients with probiotics was shorter than in the control group, but not significantly. An improvement of health in the probiotics patients occurred in 21 of 25 clinical and laboratory numerically assessed parameters (p = 0.01).

Conclusion:
Pre-operative probiotic administration (L. rhamnosus, B. breve, L. casei, L. acidophilus, B. longum) in patients undergoing colorectal resection with anastomosis resulted in faster restoration of intestinal peristalsis, and in an improved clinical state of the patients (especially reduced infection-related complications) described by 25 clinical and laboratory parameters.

Key words:
probiotics – colorectal surgery – infection complications – peristalsis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
20. 8. 2013

Accepted:
17. 1. 2014

Sources

1. Matarese LE, Seidner DL, Steiger E. The role of probiotics in gastrointestinal disease. Nutr Clin Pract 2003; 18(6): 507–516.

2. McNabb B, Isakow W. Probiotics for the prevention of nosocomial pneumonia: current evidence and opinions. Curr Opin Pulm Med 2008; 14(3): 168–175. doi: 10.1097/MCP.0b013e3282f76443.

3. Rayes N, Seehofer D, Neuhaus P. Prebiotics, probiotics, synbiotics in surgery – are they only trendy, truly effective or even dangerous? Langenbecks Arch Surg 2009; 394(3): 547–555. doi: 10.1007/s00423-008-0445-9.

4. Jeppsson B, Mangell P, Thorlacius H. Use of probiotics as prophylaxis for postoperative infections. Nutrients 2011; 3(5): 604–612. doi: 10.3390/nu3050604.

5. Nomoto K. Prevention of postoperative microbial infection by synbiotics. Indian J Exp Biol 2008; 46(8): 557–561.

6. Lundell L. Use of probiotics in abdominal surgery. Dig Dis 2011; 29(6): 570–573. doi: 10.1159/000332984.

7. Servin AL, Coconnier MH. Adhesion of probiotic strains to the intestinal mucosa and interaction with pathogens. Best Pract Res Clin Gastroenterol 2003; 17(5): 741–754.

8. Folwarski M, Dobosz M. Probiotics in surgery. Pol Przegl Chir 2010; 82(8): 489–495.

9. Howard JC, Reid G, Gan BS. Probiotics in surgical wound infections: current status. Clin Invest Med 2004, 27(5): 274–281.

10. Sugawara G, Nagino M, Nishio H et al. Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg 2006; 244(5): 706–714.

11. Kekkonen RA, Lummela N, Karjalainen H et al. Probiotic intervention has strain-specific anti-inflammatory effects in healthy adults. World J Gastroenterol 2008; 14(13): 2029–2036.

12. Gianotti L, Braga M, Morelli L et al. Role of probiotics in colorectal surgery. A prospective randomized double-blind pilot study. Nutr Ther Metab 2008; 26(4): 190–198.

13. Horvat M, Krebs B, Potrc S et al. Preoperative synbiotic bowel conditioning for elective colorectal surgery. Wien Klin Wochenschr 2010; 122(Suppl 2): 26–30. doi: 10.1007/s00508-010-1347-8.

14. Watanabe M, Murakami M, Nakao K et al. Randomized clinical trial of the influence of mechanical bowel preparation on faecal microflora in patients undergoing colonic cancer resection. Br J Surg 2010; 97(12): 1791–1797. doi: 10.1002/bjs.7253.

15. Pitsouni E, Alexiou V, Saridakis V et al. Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2009; 65(6): 561–570. doi: 10.1007/s00228-009-0642-7.

16. Liu Z, Qin H, Yang Z et al. Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and post-operative infectious complications in colorectal cancer surgery – a double-blind study. Aliment Pharmacol Ther 2011; 33(1): 50–63. doi: 10.1111/j.1365-2036.2010.04492.x.

17. Kinross JM, Markar S, Karthikesalingam A et al. A meta-analysis of probiotic and synbiotic use in elective surgery: does nutrition modulation of the gut microbiome improve clinical outcome? J Parenter Enteral Nutr 2013; 37(2): 243–253. doi: 10.1177/0148607112452306.

18. Reddy BS, Macfie J, Gatt M et al. Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg 2007; 94(5): 546–554.

19. Correia MI, Liboredo JC, Consoli ML. The role of probiotics in gastrointestinal surgery. Nutrition 2012; 28(3): 230–234. doi: 10.1016/j.nut.2011.10.013.

20. Zhang JW, Du P, Gao J et al. Preoperative probiotics decrease postoperative infectious complications of colorectal cancer. Am J Med Sci 2012; 343(3): 199–205. doi: 10.1097/MAJ.0b013e31823aace6.

21. Zahorec R. Ratio of neutrophil to lymphocyte counts – rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102(1): 5–14.