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Kanazawa et al (2005) Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy

Kanazawa et al (2005) Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy

Citation

Kanazawa H, Nagino M, Kamiya S, Komatsu S, Mayumi T, Takagi K, Asahara T, Nomoto K, Tanaka R, Nimura Y (2005) Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbeck's Archives of Surgery 390(2): 104-113. 

Objective

To investigate the effect of a synbiotic combination on patients undergoing high-risk hepatectomy, with regard to their intestinal integrity, intestinal microbiota and surgical outcome.

[Explanatory note: hepatectomy is total or partial resection of the liver]

Methods

The randomised study involved 54 patients with biliary cancer undergoing hepatectomy and receiving postoperative enteral feed. For one group, the enteral feed also contained a synbiotic combination comprising two probiotic strains (3g per day of the probiotic powder Yakult BL Seichõyaku: 1 x 108/g live Bifidobacterium breve strain Yakult; 1 x 108/g live Lactobacillus casei Shirota) and prebiotic galacto-oligosacharides (12 g per day of Oligomate 55; Yakult Honsha).

The following were analysed: lactulose/mannitol (L/M) ratio to measure intestinal permeability, serum diamine oxidase (DAO) activity, faecal microbiota and faecal organic acid concentrations.

Results

The trial was completed by 44 patients: 21 in the test group and 23 in the control group. There was no difference in postoperative changes in L/M ratios and DAO activity.

The two groups showed a postoperative difference in their faecal microbiota: there was a rise in number of bacteria considered beneficial (e.g. bifidobacteria and lactobacilli) in the synbiotic group but these decreased in the controls. Furthermore, numbers of bacteria that the researchers considered potentially harmful decreased in the synbiotic group but increased in the control (e.g. Enterobacteriaceae, Pseudomonas and Candida). Enterococci numbers increased in both groups after surgery.

The synbiotic group showed an increase in total organic acid concentrations whereas these decreased in the control group.

There was a significant decrease in infectious complications associated with the synbiotic administration, with episodes occurring in 19% (4/21) of the synbiotic group and 52% (12/23) of the control group (P

Conclusions

The authors concluded that postoperative complications can be reduced by synbiotic administration combined with early enteral nutrition.

They speculated that this could be due to improving the balance of the intestinal microbiota after it had been negative affected by the stress of surgery.

 
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