Efficacy of Probiotics and Prebiotics in Prevention of Infectious Complications Following Hepatic Resections: Systematic Review and Meta-Analysis

Abstract

Background & Aims: Infections occurring after hepatic resection cause significant morbidity, mortality, and prolonged hospitalization. Probiotics and prebiotics are considered to offer protection against post-operative infections. We aimed to determine the effect of probiotics and prebiotics on the post-operative infection rate after hepatic resection by conducting a systematic review and a meta-analysis. Method: We searched various databases, namely, the PubMed, Medline, Embase, and Cochrane Controlled Trials Registry (CENTRAL), for randomized controlled trials evaluating the effect of probiotics and/or prebiotics on the infection rate following hepatic resection. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Review was reported following the PRISMA guidelines. Results: A total of 4 studies comprising 205 patients were included for our meta-analysis. The infection rates in the probiotic group and placebo group were 11.7% and 30.3%, respectively (p<0.001). The pooled risk ratio (RR) was 0.41 (95% confidence interval [CI]: 0.128–0.730). Subgroup analysis indicated that the wound infection rate in the probiotic group (5.3%) was significantly lower than that in the placebo group (RR: 0.387, 95% CI: 0.155–0.970, p=0.043). Furthermore, probiotics/prebiotics decreased the duration of hospital stay (-0.57 days; 95% CI: -0.861 to -0.274; p<0.001) and antibiotic use (mean difference: -3.89 days, 95% CI: -4.17 to -3.60; p<0.001). There was no significant statistical heterogeneity. Conclusion: Our findings show that administration of probiotics and/or prebiotics prior to operation day decreases the infection rate post-liver resection and could shorten the duration of hospitalization and antibiotics use.