Department of Digestive and Oncological Surgery, University Hospital Lille, 59000 Lille, France.
The Francophone Group for Enhanced Recovery after Surgery, GRACE, 63110 Beaumont, France.
Nutrients. 2022 Jul 26;14(15):3066. doi: 10.3390/nu14153066.
The aims of this systematic review and meta-analysis were to assess to what extent probiotics/synbiotics reduce infectious complications after colorectal surgery and whether probiotics or synbiotics should be considered as perioperative measures preventing or reducing infectious complications after CRS and should be included in enhanced recovery programmes (ERP). Secondary aims were to answer practical questions precisely on the best formulation and the type and timing of probiotics or synbiotics in CRS.
This systematic review and quantitative meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Inclusion criteria were randomised trials comparing perioperative probiotics/synbiotics with a placebo or standard care in elective colorectal surgery. Exclusion criteria were non-randomised trials. Overall infectious complications and surgical site infections (SSIs including both deep abdominal infections and wound (skin or under the skin) infections) were the primary outcomes. Secondary outcomes were pulmonary and urinary infections, wound infections, and anastomotic leaks. The databases consulted were Medline, Cochrane Database of Systematic Reviews, Scopus, and Clinical Trials Register. Risk of bias was assessed according to the GRADE approach. The analysis calculated the random effects estimates risk ratio (RR) for each outcome.
21 trials were included; 15 evaluated probiotics, and 6 evaluated synbiotics. There were significantly fewer infectious complications (risk ratio (RR) 0.59 [0.47-0.75], I = 15%) and fewer SSI (RR 0.70 [0.52-0.95], I = 0%) in the probiotic or synbiotic group. There were also significantly fewer pulmonary infections (RR 0.35 [0.20-0.63]) and urinary infections RR 0.41 [0.19-0.87]) as opposed to anastomotic leaks (RR 0.83 [0.47-1.48]) and wound infections (RR 0.74 [0.53-1.03]). Sensitivity analyses showed no significant difference between probiotics and synbiotics in reducing postoperative infections (RR 0.55 [0.42-0.73] versus RR 0.69 [0.42-1.13], = 0.46).
Based on the finding of this study, probiotics/synbiotics reduce infectious complications after colorectal surgery. The effect size was more pronounced for pulmonary and urinary infections. From a practical aspect, some of the questions related to formulations and duration of probiotics or synbiotics need to be answered before including them definitively in enhanced recovery after colorectal surgery programmes.
本系统评价和荟萃分析的目的是评估益生菌/合生剂在结直肠手术后减少感染性并发症的程度，以及益生菌或合生剂是否应被视为预防或减少 CRS 后感染性并发症的围手术期措施，并应纳入增强恢复计划（ERP）。次要目的是准确回答关于 CRS 中益生菌/合生剂的最佳配方以及类型和时间的实际问题。
本系统评价和定量荟萃分析按照 PRISMA 2020 指南进行。纳入标准为比较择期结直肠手术中围手术期益生菌/合生剂与安慰剂或标准治疗的随机试验。排除标准为非随机试验。主要结局为总体感染性并发症和手术部位感染（包括深部腹部感染和伤口（皮肤或皮下）感染的 SSIs）。次要结局为肺部和尿路感染、伤口感染和吻合口漏。咨询的数据库包括 Medline、Cochrane 系统评价数据库、Scopus 和临床试验登记处。根据 GRADE 方法评估偏倚风险。分析计算了每个结局的随机效应估计风险比（RR）。
纳入 21 项试验；15 项评估益生菌，6 项评估合生剂。益生菌或合生剂组的感染性并发症（RR 0.59 [0.47-0.75]，I = 15%）和 SSI （RR 0.70 [0.52-0.95]，I = 0%）明显减少。肺部感染（RR 0.35 [0.20-0.63]）和尿路感染（RR 0.41 [0.19-0.87]）也明显减少，而吻合口漏（RR 0.83 [0.47-1.48]）和伤口感染（RR 0.74 [0.53-1.03]）则相反。敏感性分析显示，益生菌和合生剂在减少术后感染方面没有显著差异（RR 0.55 [0.42-0.73]与 RR 0.69 [0.42-1.13]，= 0.46）。
基于本研究的发现，益生菌/合生剂可减少结直肠手术后的感染性并发症。对肺部和尿路感染的影响更大。从实际角度来看，在将益生菌或合生剂明确纳入结直肠手术后的增强恢复计划之前，需要回答一些与配方和持续时间相关的问题。
