Perioperative Pro-/Synbiotic For Colorectal Surgery: A Systematic Review And Updated Meta-Analysis Of Randomized Controlled Trials

Aim Perioperative pro-/synbiotic therapy is widely used in surgical patients to reduce infections and enhance recovery. However, it remains controversial when used in colorectal surgery. We performed this meta-analysis to assess the efficacy of perioperative pro-/synbiotic in colorectal surgery. Methods After the literature search of PubMed, Embase, Cochrane Library and Web of Science, a systematic review and meta-analysis were performed on randomized controlled trials. Quality assessment and data extraction were performed. The main outcomes included total postoperative infectious complications, pneumonia, wound infection, intra-abdominal abscess, urinary infection and length of hospital stay. Results: Thirteen trials (total, 1301 patients) were included based on the criteria. Perioperative pro-/synbiotic administration was associated with a significant reduction in total postoperative infectious complications (RR 0.58, 95% CI, 0.46 to 0.73, P < 0.00001), pneumonia (RR 0.31, 95% CI, 0.14 to 0.66, P = 0.003), wound infection (RR 0.66, 95% CI, 0.49 to 0.88 P = 0.005) and length of hospital stay (WMD -1.97, 95% CI, -3.44 to -0.50, P = 0.009) in patients undergoing elective colorectal surgery. No significant differences were found in the incidence of intra-abdominal abscess or urinary infection. Conclusion: Perioperative pro-/synbiotic administration in patients undergoing elective colorectal surgery appeared to improve clinical outcomes. Use of multiple trains should be recommended in future clinical practices.