Postoperative infectious complication (POIC) is one of the most common complications following highly invasive abdominal surgeries, such as hepatectomy, esophagectomy, and pancreatoduodenectomy. The surgical stress temporarily deteriorates the intestinal microenvironment, and the fecal concentrations of beneficial bacteria such as Bifidobacterium and Lactobacillus decrease following highly invasive abdominal surgery. In parallel with these changes, the concentrations of fecal short-chain fatty acids (SCFAs) such as acetic acid, propionic acid, and butyric acid also decrease after surgery. In contrast, the fecal concentration of lactic acid increases under this condition because of the deterioration of the metabolism from lactic acid to SCFAs by normal intestinal microflora. Decreased fecal concentration of SCFAs may lead to an impaired intestinal barrier function under stressful condition. Translocation of bacteria from the gut to lymphatic and bloodstream leads to bacteremia and subsequent POICs. The incidence of POICs in patients with unhealthy intestinal microflora before surgery may be more because their intestine is more susceptible to bacterial translocation induced by surgical stress. Therefore, improving the intestinal microenvironment and intestinal barrier function before surgery is crucial to prevent POICs following highly invasive abdominal surgeries. In this regard, the use preoperative synbiotics therapy may be one of the effective ways because it has been shown to improve intestinal microflora, increase fecal SCFAs, prevent bacterial translocation, and reduce the incidence of POICs in several randomized controlled trial in patients undergoing highly invasive abdominal surgeries.

1.
Kanazawa H, Nagino M, Kamiya S, Komatsu S, Mayumi T, Takagi K, et al: Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg 2005;390:104-113.
2.
Sugawara G, Nagino M, Nishio H, Ebata T, Takagi K, Asahara T, et al: Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg 2006;244:706-714.
3.
Mizuno T, Yokoyama Y, Nishio H, Ebata T, Sugawara G, Asahara T, et al: Intraoperative bacterial translocation detected by bacterium-specific ribosomal Rna-targeted reverse-transcriptase polymerase chain reaction for the mesenteric lymph node strongly predicts postoperative infectious complications after major hepatectomy for biliary malignancies. Ann Surg 2010;252:1013-1019.
4.
Nishigaki E, Abe T, Yokoyama Y, Fukaya M, Asahara T, Nomoto K, et al: The detection of intraoperative bacterial translocation in the mesenteric lymph nodes is useful in predicting patients at high risk for postoperative infectious complications after esophagectomy. Ann Surg 2014;259:477-484.
5.
Yamaguchi N, Yokoyama Y, Ebata T, Igami T, Sugawara G, Asahara T, et al: Intermittent Pringle maneuver is unlikely to induce bacterial translocation to the portal vein: a study using bacterium-specific ribosomal RNA-targeted reverse transcription-polymerase chain reaction. J Hepatobiliary Pancreat Sci 2015;22:491-497.
6.
Yokoyama Y, Mizuno T, Sugawara G, Asahara T, Nomoto K, Igami T, et al: Profile of preoperative fecal organic acids closely predicts the incidence of postoperative infectious complications after major hepatectomy with extrahepatic bile duct resection: importance of fecal acetic acid plus butyric acid minus lactic acid gap. Surgery 2017;pii: S0039-6060(17)30329-X.
7.
Tanaka K, Yano M, Motoori M, Kishi K, Miyashiro I, Ohue M, et al: Impact of perioperative administration of synbiotics in patients with esophageal cancer undergoing esophagectomy: a prospective randomized controlled trial. Surgery 2012;152:832-842.
8.
Kimura I, Inoue D, Maeda T, Hara T, Ichimura A, Miyauchi S, et al: Short-chain fatty acids and ketones directly regulate sympathetic nervous system via G protein-coupled receptor 41 (GPR41). Proc Natl Acad Sci U S A 2011;108:8030-8035.
9.
Ichimura A, Hirasawa A, Poulain-Godefroy O, Bonnefond A, Hara T, Yengo L, et al: Dysfunction of lipid sensor GPR120 leads to obesity in both mouse and human. Nature 2012;483:350-354.
10.
Fukuda S, Toh H, Hase K, Oshima K, Nakanishi Y, Yoshimura K, et al: Bifidobacteria can protect from enteropathogenic infection through production of acetate. Nature 2011;469:543-547.
11.
Canani RB, Costanzo MD, Leone L, Pedata M, Meli R, Calignano A: Potential beneficial effects of butyrate in intestinal and extraintestinal diseases. World J Gastroenterol 2011;17:1519-1528.
12.
Yadav H, Lee JH, Lloyd J, Walter P, Rane SG: Beneficial metabolic effects of a probiotic via butyrate-induced GLP-1 hormone secretion. J Biol Chem 201330;288:25088-25097.
13.
Furusawa Y, Obata Y, Fukuda S, Endo TA, Nakato G, Takahashi D, et al: Commensal microbe-derived butyrate induces the differentiation of colonic regulatory T cells. Nature 2013;504:446-450.
14.
Huang W, Guo HL, Deng X, Zhu TT, Xiong JF, Xu YH, et al: Short-chain fatty acids inhibit oxidative stress and inflammation in mesangial cells induced by high glucose and lipopolysaccharide. Exp Clin Endocrinol Diabetes 2017;125:98-105.
15.
Endo H, Niioka M, Kobayashi N, Tanaka M, Watanabe T: Butyrate-producing probiotics reduce nonalcoholic fatty liver disease progression in rats: new insight into the probiotics for the gut-liver axis. PLoS One 2013;8:e63388.
16.
Alverdy JC, Laughlin RS, Wu L: Influence of the critically ill state on host-pathogen interactions within the intestine: gut-derived sepsis redefined. Crit Care Med 2003;31:598-607.
17.
Hayakawa M, Asahara T, Henzan N, Murakami H, Yamamoto H, Mukai N, et al: Dramatic changes of the gut flora immediately after severe and sudden insults. Dig Dis Sci 2011;56:2361-2365.
18.
Takagi K, Nakao M, Ogura Y, Nabeshima T, Kunii A: Sensitive colorimetric assay of serum diamine oxidase. Clin Chim Acta 1994;226:67-75.
19.
Usami M, Miyoshi M, Kanbara Y, Aoyama M, Sakaki H, Shuno K, et al: Effects of perioperative synbiotic treatment on infectious complications, intestinal integrity, and fecal flora and organic acids in hepatic surgery with or without cirrhosis. JPEN J Parenter Enteral Nutr 2011;35:317-328.
20.
Matsuda K, Tsuji H, Asahara T, Kado Y, Nomoto K: Sensitive quantitative detection of commensal bacteria by rRNA-targeted reverse transcription-PCR. Appl Environ Microbiol 2007;73:32-39.
21.
Matsuda K, Tsuji H, Asahara T, Matsumoto K, Takada T, Nomoto K: Establishment of an analytical system for the human fecal microbiota, based on reverse transcription-quantitative PCR targeting of multicopy rRNA molecules. Appl Environ Microbiol 2009;75:1961-1969.
22.
Rayes N, Seehofer D, Hansen S, Boucsein K, Muller AR, Serke S, et al: Early enteral supply of lactobacillus and fiber versus selective bowel decontamination: a controlled trial in liver transplant recipients. Transplantation 2002;74:123-127.
23.
Rayes N, Seehofer D, Theruvath T, Schiller RA, Langrehr JM, Jonas S, et al: Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation-a randomized, double-blind trial. Am J Transplant 2005;5:125-130.
24.
Eguchi S, Takatsuki M, Hidaka M, Soyama A, Ichikawa T, Kanematsu T: Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation: a prospective randomized study. Am J Surg 2011;201:498-502.
25.
Rayes N, Pilarski T, Stockmann M, Bengmark S, Neuhaus P, Seehofer D: Effect of pre- and probiotics on liver regeneration after resection: a randomised, double-blind pilot study. Benef Microbes 2012;3:237-244.
26.
Yokoyama Y, Nishigaki E, Abe T, Fukaya M, Asahara T, Nomoto K, et al: Randomized clinical trial of the effect of perioperative synbiotics versus no synbiotics on bacterial translocation after oesophagectomy. Br J Surg 2014;101:189-199.
27.
Yokoyama Y, Miyake T, Kokuryo T, Asahara T, Nomoto K, Nagino M: Effect of perioperative synbiotic treatment on bacterial translocation and postoperative infectious complications after pancreatoduodenectomy. Dig Surg 2016;33:220-229.
28.
Rayes N, Seehofer D, Theruvath T, Mogl M, Langrehr JM, Nussler NC, et al: Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind trial. Ann Surg 2007;246:36-41.
You do not currently have access to this content.