Best Probiotic For BV

Although colorectal surgery (CRS) has seen significant improvements in surgical care, it still has substantial postoperative infectious complications, such as surgical site infections.

Several medical measures can reduce the incidence of such complications, both preoperatively ( improve nutrition, decontaminate the colon using oral antibiotics and intravenous antibiotics) and intraoperatively (prevent hypothermia, supplement oxygen, prepare the skin, protect the abdominal wall, and perform minimally invasive surgery).

This systematic review and meta-analysis aimed to determine the extent to which probiotics/synbiotics reduce infectious complications following colorectal surgery. Also, the researchers examined whether probiotics or synbiotics should be included in enhanced recovery programs (ERP) for preventing or reducing infectious complications after CRS.

A recent study suggests that oral antibiotics (OABs) reduce surgical-site infections without mechanical bowel preparation, despite the ongoing debate over the role of mechanical bowel preparation with oral antibiotics.

Compared to bowel preparation, using perioperative probiotics and synbiotics to reduce infectious complications after CRS is relatively understudied. These dietary supplements are available in three formulations.

Several early reports showed that probiotics and synbiotics enhanced gut microflora, intestinal structure, function, and local immune responses. In addition to being useful preoperatively to reduce pathogenic bacteria overgrowth (by preserving the mucosal gut barrier), medical experts can use them perioperatively to reduce infectious complications (by protecting the mucosal gut barrier). 

Published trials, however, offer conflicting results, and the heterogeneity of dosages, timing, duration, and strains precludes any definitive conclusions based on these findings.

By the consensus statement of ISAPP (International Scientific Association for Probiotics and Prebiotics), probiotics are living microorganisms that have health benefits when administered in adequate amounts.

The experts used PRISMA 2020 guidelines to conduct this systematic review and quantitative meta-analysis. The inclusion criteria were randomized trials comparing perioperative probiotics/synbiotics with placebos or standard care for elective colorectal surgery. Non-randomized trials were excluded.

The primary outcomes were infectious complications and surgical site infections (SSIs, including deep abdominal infections and wound infections under the skin). Secondary outcomes included pulmonary and urinary infections, wound infections, and anastomotic leaks.

The researchers consulted Medline, the Cochrane Database of Systematic Reviews, Scopus, and the Clinical Trials Register based on the GRADE approach. Then, based on random effects estimates, risk ratios (RRs) were calculated for each outcome, and The researchers included 21 trials; 15 evaluated probiotics and six evaluated synbiotics.

The probiotic or synbiotic group had fewer infectious complications, fewer SSI, and fewer pulmonary and urinary infections than the anastomotic leak and wound infection groups.

Neither probiotics nor synbiotics reduced postoperative infections significantly in sensitivity analyses.

This meta-analysis confirms that probiotics or synbiotics reduce infectious complications after colorectal surgery.

From a practical standpoint, however, it is still necessary to examine the timing and formulation of probiotics and synbiotics before they are formally included in enhanced recovery programs (after colorectal surgery). In addition, the effect size is more significant for “non-surgical” infectious complications.

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