Do Synbiotics Reduce Infections in Foregut Surgery?

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The perioperative administration of synbiotics (a combination of probiotics and prebiotics) has been associated with a relative risk reduction in postoperative infectious complications of 50% for patients undergoing general surgery. Major foregut surgery includes oesophagectomy, gastrectomy, distal pancreatectomy, pancreaticoduodenectomy, and liver resections. These operations have a relatively high incidence of postoperative infections complications. From our locally maintained prospective database at St Vincent’s Hospital, the rate of infectious complications following major foregut surgery is 31%. This patient population will have preoperative dysbiosis due to the underlying pathology, neoadjuvant chemotherapy and radiotherapy, medications including antibiotics, weight loss, stress, and diet. They could gain significantly from interventions aimed at improving their microbiota and clinical outcomes. We propose a randomised, placebo-controlled, double-blinded trial to assess perioperative synbiotic administration's effectiveness on reducing postoperative infections in major foregut surgery patients. Additional clinical outcomes will assess the impact of synbiotics on time to first bowel movement, length of stay in intensive care, length of hospital stay, antibiotic therapy duration, and mortality. We will also perform a scientific examination of faecal microbiota and assess intestinal permeability and systemic inflammation. By examining whether changes in clinical outcomes are correlated with alterations in these measures, we aim to understand the mechanism of action of synbiotics further.

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