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The Role of Probiotics in Surgery
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The Role of Probiotics in Surgery

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Prebiotics and Probiotics".

Deadline for manuscript submissions: closed (18 May 2023) | Viewed by 21565

Special Issue Editor

Dr. Katerina Kotzampassi

E-Mail Website
Guest Editor
Department of Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Interests: probiotics; nutrition; body composition; obesity treatment; endoscopic surgery; colorectal surgery;interventional endoscopy, surgery, colon surgery, obesity, experimental surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There is increasing evidence that the general health status of the human microbiome is of particular importance, since the majority of infections and non-infectious complications which occur in a hospitalized individual originate from their own microbiome. Especially in the case of a patient scheduled for surgery—of any kind and particularly of the gastrointestinal tract—a variety of factors may rapidly modify the microbiota counts, diversity, and proportion of their constituents: pre-operative preparations, fasting, the stress of anesthesia and operation itself, tissue hypoperfusion, as well as antibiotics and other medications.

In recent years, significant scientific interest and extensive research have focused on the use of probiotics in surgical patients; this is both clinical, to lower the risk of surgical infections and surgical-related complications, and basic investigation, behind the mechanisms of probiotics mode of action and microbiome modulation. However, many questions regarding the type of probiotics, the proper combinations of different genes, the dose, and the beginning and duration of treatment remain still unanswered.

Based on your insights and expertise in the field of probiotics, we invite both basic researchers and clinical investigators to contribute to this Special Issue of Nutrients with their recent research findings. Looking for a multidisciplinary and multifaceted approach on the topic of “probiotics in surgery”, we welcome the submission of original research in both human and animal models, as well as narrated and systematic reviews and meta-analyses. Potential topics include:

  • Effective prevention of surgical site infections and surgical-related complications by means of probiotics—clinical findings and underlying mechanisms;
  • Postoperative antibiotic-related complications;
  • Gut microbiome alterations and anastomotic dehiscence—the role of probiotics;
  • Gut microbiome and pneumonia—the role of probiotics;
  • Surgical wound infection and microbiome: gut or skin origin? Probiotics modulation.

Dr. Katerina Kotzampassi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • probiotics
  • surgery
  • wound infection
  • postoperative complications
  • antibiotic-related complications
  • microbiome modulation
  • mechanism of action

Published Papers (9 papers)

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Editorial

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9 pages, 278 KiB  
Editorial
Why Give My Surgical Patients Probiotics
by Katerina Kotzampassi
Nutrients 2022, 14(20), 4389; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14204389 - 19 Oct 2022
Cited by 3 | Viewed by 1522
Abstract
Although there are various hypotheses on the health-promoting roles probiotic supplementation play—via targeting the gut microbiota and/or regulating the systemic immune and metabolic responses—the precise nature of this benefit in restitution of health following surgery remains under discussion and in doubt [...] Full article
(This article belongs to the Special Issue The Role of Probiotics in Surgery)
5 pages, 231 KiB  
Editorial
What Surgeon Should Know about Probiotics
by Katerina Kotzampassi
Nutrients 2022, 14(20), 4374; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14204374 - 19 Oct 2022
Cited by 4 | Viewed by 1414
Abstract
Back in the 1980s, Fuller R, when working on gut flora, concluded that “there is good evidence that the complex microbial flora present in the gastrointestinal tract … is effective in providing resistance to disease; however, the composition of this protective flora can [...] Read more.
Back in the 1980s, Fuller R, when working on gut flora, concluded that “there is good evidence that the complex microbial flora present in the gastrointestinal tract … is effective in providing resistance to disease; however, the composition of this protective flora can be altered by dietary and environmental influences, making the host susceptible to disease” [...] Full article
(This article belongs to the Special Issue The Role of Probiotics in Surgery)

Research

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14 pages, 2241 KiB  
Article
Role of Lactiplantibacillus plantarum UBLP-40, Lactobacillus rhamnosus UBLR-58 and Bifidobacterium longum UBBL-64 in the Wound Healing Process of the Excisional Skin
by Dimitrios Panagiotou, Eirini Filidou, Maria Gaitanidou, Gesthimani Tarapatzi, Michail Spathakis, Leonidas Kandilogiannakis, George Stavrou, Konstantinos Arvanitidis, Joulia K. Tsetis, Persefoni Gionga, Anne D. Shrewsbury, Vangelis G. Manolopoulos, Dora Kapoukranidou, Konstantinos Lasithiotakis, George Kolios and Katerina Kotzampassi
Nutrients 2023, 15(8), 1822; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15081822 - 10 Apr 2023
Cited by 4 | Viewed by 1818
Abstract
The probiotics Lactiplantibacillus plantarum UBLP-40, Lactobacillus rhamnosus UBLR-58 and Bifidobacterium longum UBBL-64 seem to promote wound healing when applied topically. Our aim was to investigate their effect on the mRNA expression of pro-inflammatory, healing and angiogenetic factors during the healing process of a [...] Read more.
The probiotics Lactiplantibacillus plantarum UBLP-40, Lactobacillus rhamnosus UBLR-58 and Bifidobacterium longum UBBL-64 seem to promote wound healing when applied topically. Our aim was to investigate their effect on the mRNA expression of pro-inflammatory, healing and angiogenetic factors during the healing process of a standardized excisional wound model in rats. Rats subjected to six dorsal skin wounds were allocated to Control; L. plantarum; combined formula of L. rhamnosus plus B. longum; L. rhamnosus; and B. longum treatments, applied every two days, along with tissue collection. The pro-inflammatory, wound-healing, and angiogenetic factors of mRNA expression were assessed by qRT-PCR. We found that L. plantarum exerts a strong anti-inflammatory effect in relation to L. rhamnosus–B. longum, given alone or in combination; the combined regime of L. rhamnosus–B. longum, works better, greatly promoting the expression of healing and angiogenic factors than L. plantarum. When separately tested, L. rhamnosus was found to work better than B. longum in promoting the expression of healing factors, while B. longum seems stronger than L. rhamnosus in the expression of angiogenic factors. We, therefore, suggest that an ideal probiotic treatment should definitively contain more than one probiotic strain to speed up all three healing phases. Full article
(This article belongs to the Special Issue The Role of Probiotics in Surgery)
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12 pages, 489 KiB  
Article
A Four-Probiotic Regime to Reduce Surgical Site Infections in Multi-Trauma Patients
by Georgios Tzikos, Despoina Tsalkatidou, George Stavrou, Giannoula Thoma, Angeliki Chorti, Maria Tsilika, Antonios Michalopoulos, Theodosios Papavramidis, Evangelos J. Giamarellos-Bourboulis and Katerina Kotzampassi
Nutrients 2022, 14(13), 2620; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14132620 - 24 Jun 2022
Cited by 6 | Viewed by 1950
Abstract
Investigations that focused on the protective role of probiotics against Surgical Site Infections (SSI) in multiple-trauma (MT) patients are generally few, probably due to the complexity of the concept of trauma. We aimed to assess the efficacy of a four-probiotic regime to reduce [...] Read more.
Investigations that focused on the protective role of probiotics against Surgical Site Infections (SSI) in multiple-trauma (MT) patients are generally few, probably due to the complexity of the concept of trauma. We aimed to assess the efficacy of a four-probiotic regime to reduce the incidence of SSI in MT patients, with a brain injury included. MT patients, being intubated and expected to require mechanical ventilation for >10 days, were randomly allocated into placebo (n = 50) or probiotic treatment (n = 53) comprising Lactobacillus acidophilus LA-5 (1.75 × 109 cfu), Lactiplantibacillus plantarum UBLP-40 (0.5 × 109 cfu), Bifidobacterium animalis subsp. lactis BB-12 (1.75 × 109 cfu), and Saccharomycesboulardii Unique-28 (1.5 × 109 cfu) in sachets. All patients received two sachets of placebo or probiotics twice/day for 15 days and were followed-up for 30 days. The operations were classified as neurosurgical, thoracostomies, laparotomies, orthopedics, and others; then, the SSI and the isolated pathogen were registered. A total of 23 (46.0%) and 13 (24.5%) infectious insults in 89 (50 placebo patients) and 88 (53 probiotics-treated) operations (p = 0.022) were recorded, the majority of them relating to osteosynthesis—17 and 8, respectively. The most commonly identified pathogens were Staphylococcus aureus and Acinetobacter baumannii. Our results support published evidence that the prophylactic administration of probiotics in MT patients exerts a positive effect on the incidence of SSI. Full article
(This article belongs to the Special Issue The Role of Probiotics in Surgery)
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Review

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23 pages, 1127 KiB  
Review
Looking for the Ideal Probiotic Healing Regime
by Alexandra Menni, Moysis Moysidis, Georgios Tzikos, George Stavrou, Joulia K. Tsetis, Anne D. Shrewsbury, Eirini Filidou and Katerina Kotzampassi
Nutrients 2023, 15(13), 3055; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15133055 - 06 Jul 2023
Cited by 2 | Viewed by 1694
Abstract
Wound healing is a multi-factorial response to tissue injury, aiming to restore tissue continuity. Numerous recent experimental and clinical studies clearly indicate that probiotics are applied topically to promote the wound-healing process. However, the precise mechanism by which they contribute to healing is [...] Read more.
Wound healing is a multi-factorial response to tissue injury, aiming to restore tissue continuity. Numerous recent experimental and clinical studies clearly indicate that probiotics are applied topically to promote the wound-healing process. However, the precise mechanism by which they contribute to healing is not yet clear. Each strain appears to exert a distinctive, even multi-factorial action on different phases of the healing process. Given that a multi-probiotic formula exerts better results than a single strain, the pharmaceutical industry has embarked on a race for the production of a formulation containing a combination of probiotics capable of playing a role in all the phases of the healing process. Hence, the object of this review is to describe what is known to date of the distinctive mechanisms of each of the most studied probiotic strains in order to further facilitate research toward the development of combinations of strains and doses, covering the whole spectrum of healing. Eleven probiotic species have been analyzed, the only criterion of inclusion being a minimum of two published research articles. Full article
(This article belongs to the Special Issue The Role of Probiotics in Surgery)
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14 pages, 328 KiB  
Review
The Role of Probiotics in Inflammation Associated with Major Surgery: A Narrative Review
by Rafail Matzaras, Nikolaos Anagnostou, Anna Nikopoulou, Ilias Tsiakas and Eirini Christaki
Nutrients 2023, 15(6), 1331; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15061331 - 08 Mar 2023
Cited by 1 | Viewed by 2500
Abstract
Background: Gut microbiota is well-known for its ability to maintain intestinal homeostasis. However, the disruption of this homeostasis, known as dysbiosis, leads to multiple consequences, including local and systemic inflammation. Surgery-induced inflammation is a major concern for patients, as it leads to many [...] Read more.
Background: Gut microbiota is well-known for its ability to maintain intestinal homeostasis. However, the disruption of this homeostasis, known as dysbiosis, leads to multiple consequences, including local and systemic inflammation. Surgery-induced inflammation is a major concern for patients, as it leads to many infectious and non-infectious complications. Objective: The purpose of this review was to explore the role of probiotics and symbiotics in surgery-induced inflammation and to determine if their use is effective in combatting inflammation and its complications Methods and Materials: A literature search was conducted, and articles published only in English, until December 2022 were included. The results are reported in the form of a narrative review. Results: The perioperative use of probiotics and/or symbiotics results in lower risk of infectious complications, including reduced rates of surgical site infections, respiratory and urinary tract infections, shorter hospital stays, and fewer days of antibiotic administration. It also contributes to reducing non-infectious complications, as it mitigates systemic and local inflammation via maintenance of the intestinal barrier, improves intestinal mobility, and is associated with lower rates of postoperative pain and anastomotic leak. Conclusions: Restoring gut microbiota after disruptions caused by surgery may accelerate local healing processes, attenuate systemic inflammation, and may thus prove beneficial to certain populations. Full article
(This article belongs to the Special Issue The Role of Probiotics in Surgery)
12 pages, 304 KiB  
Review
Gestational Diabetes, Colorectal Cancer, Bariatric Surgery, and Weight Loss among Diabetes Mellitus Patients: A Mini Review of the Interplay of Multispecies Probiotics
by Emmanouil Benioudakis, Eleni Karlafti, Alexandra Bekiaridou, Triantafyllos Didangelos and Theodossis S. Papavramidis
Nutrients 2022, 14(1), 192; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14010192 - 31 Dec 2021
Cited by 7 | Viewed by 2966
Abstract
Diabetes mellitus has been steadily increasing over the past decades and is one of the most significant global public health concerns. Diabetes mellitus patients have an increased risk of both surgical and post-surgical complications. The post-surgical risks are associated with the primary condition [...] Read more.
Diabetes mellitus has been steadily increasing over the past decades and is one of the most significant global public health concerns. Diabetes mellitus patients have an increased risk of both surgical and post-surgical complications. The post-surgical risks are associated with the primary condition that led to surgery and the hyperglycaemia per se. Gut microbiota seems to contribute to glucose homeostasis and insulin resistance. It affects the metabolism through body weight and energy homeostasis, integrating the peripheral and central food intake regulatory signals. Homeostasis of gut microbiota seems to be enhanced by probiotics pre and postoperatively. The term probiotics is used to describe some species of live microorganisms that, when administered in adequate amounts, confer health benefits on the host. The role of probiotics in intestinal or microbial skin balance after abdominal or soft tissue elective surgeries on DM patients seems beneficial, as it promotes anti-inflammatory cytokine production while increasing the wound-healing process. This review article aims to present the interrelation of probiotic supplements with DM patients undergoing elective surgeries. Full article
(This article belongs to the Special Issue The Role of Probiotics in Surgery)

Other

16 pages, 3121 KiB  
Systematic Review
Probiotics/Synbiotics to Reduce Infectious Complications after Colorectal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
by Julie Veziant, Mathilde Bonnet, Bob V. Occean, Chadly Dziri, Bruno Pereira and Karem Slim
Nutrients 2022, 14(15), 3066; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14153066 - 26 Jul 2022
Cited by 12 | Viewed by 2154
Abstract
Aim: The aims of this systematic review and meta-analysis were to assess to what extent probiotics/synbiotics reduce infectious complications after colorectal surgery and whether probiotics or synbiotics should be considered as perioperative measures preventing or reducing infectious complications after CRS and should be [...] Read more.
Aim: The aims of this systematic review and meta-analysis were to assess to what extent probiotics/synbiotics reduce infectious complications after colorectal surgery and whether probiotics or synbiotics should be considered as perioperative measures preventing or reducing infectious complications after CRS and should be included in enhanced recovery programmes (ERP). Secondary aims were to answer practical questions precisely on the best formulation and the type and timing of probiotics or synbiotics in CRS. Method: This systematic review and quantitative meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Inclusion criteria were randomised trials comparing perioperative probiotics/synbiotics with a placebo or standard care in elective colorectal surgery. Exclusion criteria were non-randomised trials. Overall infectious complications and surgical site infections (SSIs including both deep abdominal infections and wound (skin or under the skin) infections) were the primary outcomes. Secondary outcomes were pulmonary and urinary infections, wound infections, and anastomotic leaks. The databases consulted were Medline, Cochrane Database of Systematic Reviews, Scopus, and Clinical Trials Register. Risk of bias was assessed according to the GRADE approach. The analysis calculated the random effects estimates risk ratio (RR) for each outcome. Results: 21 trials were included; 15 evaluated probiotics, and 6 evaluated synbiotics. There were significantly fewer infectious complications (risk ratio (RR) 0.59 [0.47–0.75], I2 = 15%) and fewer SSI (RR 0.70 [0.52–0.95], I2 = 0%) in the probiotic or synbiotic group. There were also significantly fewer pulmonary infections (RR 0.35 [0.20–0.63]) and urinary infections RR 0.41 [0.19–0.87]) as opposed to anastomotic leaks (RR 0.83 [0.47–1.48]) and wound infections (RR 0.74 [0.53–1.03]). Sensitivity analyses showed no significant difference between probiotics and synbiotics in reducing postoperative infections (RR 0.55 [0.42–0.73] versus RR 0.69 [0.42–1.13], p = 0.46). Conclusions: Based on the finding of this study, probiotics/synbiotics reduce infectious complications after colorectal surgery. The effect size was more pronounced for pulmonary and urinary infections. From a practical aspect, some of the questions related to formulations and duration of probiotics or synbiotics need to be answered before including them definitively in enhanced recovery after colorectal surgery programmes. Full article
(This article belongs to the Special Issue The Role of Probiotics in Surgery)
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14 pages, 283 KiB  
Systematic Review
Probiotics and Their Effect on Surgical Wound Healing: A Systematic Review and New Insights into the Role of Nanotechnology
by Alexandra Bekiaridou, Eleni Karlafti, Ilias Marios Oikonomou, Aristidis Ioannidis and Theodossis S. Papavramidis
Nutrients 2021, 13(12), 4265; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13124265 - 26 Nov 2021
Cited by 19 | Viewed by 4107
Abstract
Skin tissue repair is of fundamental importance for maintaining homeostasis regulation, protection barrier, absorption, and excretion of skin tissue. Wound healing is a complicated process that can be impaired by infections and therefore have a significant economic and social impact. Simultaneously, the overuse [...] Read more.
Skin tissue repair is of fundamental importance for maintaining homeostasis regulation, protection barrier, absorption, and excretion of skin tissue. Wound healing is a complicated process that can be impaired by infections and therefore have a significant economic and social impact. Simultaneously, the overuse of antibiotics has led to antimicrobial resistance and loss of their efficacy. Thus, the need for alternative antimicrobial agents is urgent. The newest approaches on wound dressings employ new therapeutic agents, such as probiotics. Probiotics alone or in tandem with nanotechnology-based techniques exhibit a broad range of benefits on surgical wounds. This systematic review aims to consider current knowledge of probiotic effects on animals and humans regarding surgical wound healing and provide new insights into the role of nanotechnology. The databases included were PubMed (MEDLINE), Scopus, and Cochrane Library (CENTRAL). Studies focused on burns, chronic wounds, and diabetic ulcers were excluded. The promising industry of probiotics demonstrates a significant upsurge as more and more healthy individuals rely their well-being on alternative medicine. Included probiotics illustrated positive results on wound re-epithelization, neovascularization, and wound healing. No adverse effects were noted. Full article
(This article belongs to the Special Issue The Role of Probiotics in Surgery)
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