The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Randomized clinical trial of the effect of perioperative synbiotics versus no synbiotics on bacterial translocation after oesophagectomy. BJS 2014; 101: 189-199.

Published: 9th January 2014

Authors: Y. Yokoyama, E. Nishigaki, T. Abe, M. Fukaya, T. Asahara, K. Nomoto et al.

Background

The impact of perioperative synbiotics on bacterial translocation and subsequent bacteraemia after oesophagectomy is unclear. This study investigated the effect of perioperative synbiotic administration on the incidence of bacterial translocation to mesenteric lymph nodes (MLNs) and the occurrence of postoperative bacteraemia.

Method

Patients with oesophageal cancer were randomized to receive perioperative synbiotics or no synbiotics (control group). MLNs were harvested from the jejunal mesentery before dissection (MLN‐1) and after the restoration of digestive tract continuity (MLN‐2). Blood and faeces samples were taken before and after operation. Microorganisms in each sample were detected using a bacterium‐specific ribosomal RNA‐targeted reverse transcriptase–quantitative polymerase chain reaction (RT‐qPCR) method.

Results

Some 42 patients were included. There was a significant difference between the two groups in detection levels of microorganisms in the MLN‐1 samples. Microorganisms were more frequently detected in MLN‐2 samples in the control group than in the synbiotics group (10 of 18 versus 3 of 18; P = 0·035). In addition, bacteraemia detected using RT‐qPCR 1 day after surgery was more prevalent in the control group than in the synbiotics group (12 of 21 versus 4 of 21; P = 0·025). Neutrophil counts on postoperative days 1, 2 and 7 after surgery were all significantly higher in the control group than in the synbiotics group.

Conclusion

Perioperative use of synbiotics reduces the incidence of bacteria in the MLNs and blood. These beneficial effects probably contribute to a reduction in the inflammatory response after oesophagectomy. Registration number: ID 000003262 (University Hospital Medical Information Network, http://www.umin.ac.jp).

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