Preoperative synbiotic bowel conditioning for elective colorectal surgery.
BACKGROUND
Preoperative bowel cleaning for elective colorectal surgery is a routine procedure. Synbiotics (probiotics plus prebiotics) are known for their beneficial effects on gut immune function and maintenance of the gut barrier. The main purpose of this study was to replace preoperative mechanical bowel cleaning with synbiotics and to assess the systemic inflammatory response and clinical outcome in patients undergoing colorectal surgery.


METHODS
A prospective double-blind randomized placebo-controlled trial was conducted in 68 patients. The first group of 20 patients received synbiotics, the second group of 28 patients prebiotics and heat-deactivated probiotics, and the third (control) group of 20 patients mechanical bowel cleaning prior to the operation.


RESULTS
Significantly higher values of interleukin 6 (IL-6) were detected 72 h after the operation in the synbiotic group (P = 0.025), as well as an increase of fibrinogen at 24 h postoperatively (P = 0.030). No statistical differences were found in leukocytes count, C-reactive protein or the lymphocyte/granulocyte ratio. There were no differences in postoperative complications between the groups. Mean hospital stay was 9.2 days in the prebiotic group, 9.5 days in the control group, and 10.95 days in the synbiotic group.


CONCLUSIONS
Preoperative administration of prebiotics in elective colorectal surgery appears to have the same protective effect in preventing a postoperative inflammatory response as mechanical bowel cleaning. Further prospective studies are needed to verify the effects of synbiotics.
Department for Abdominal and General Surgery, Clinic for Surgery, University Clinical Center Maribor, Maribor, Slovenia. matjaz.horvat@ukc-mb.si
Matjaz
M
Horvat
Bojan
B
Krebs
Stojan
S
Potrc
Arpad
A
Ivanecz
Lidija
L
Kompan
D000230:Adenocarcinoma / Q000601:surgery*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000880:Anthraquinones / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000378:metabolism; D002400:Cathartics / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000601:surgery*; D004311:Double-Blind Method; D004573:Electrolytes; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D056692:Prebiotics; D011300:Preoperative Care / Q000379:methods*; D019936:Probiotics / Q000008:administration & dosage*; D011446:Prospective Studies; D007507:Therapeutic Irrigation
D000880:Anthraquinones; D002400:Cathartics; D004573:Electrolytes; C033608:Golytely; D018836:Inflammation Mediators; D015850:Interleukin-6; D056692:Prebiotics; D011092:Polyethylene Glycols; C029418:X-prep; D005340:Fibrinogen; D002097:C-Reactive Protein