Objective  To systematically review the effectiveness of perioperative oral probiotics in hepatic resection patients, and provide evidence-based clinical evidence.

Methods PubMed, Cochrane Library, Web of Science, EMbase, SinoMed, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on perioperative oral probiotics in hepatectomized patients from inception to June 30, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed by RevMan 5.4 software.

Results  A total of 10 RCTs were included, including 715 patients. The Meta-analysis showed that compared to placebo or blank controls, the incidence of postoperative infections in oral probiotic patients (RR=0.60, 95%CI 0.48 to 0.74, P<0.001), serum endotoxin levels (MD=-0.88, 95%CI -1.53 to -0.22, P=0.009), cumulative antibiotic use (MD=-1.48, 95%CI -2.17 to -0.78, P<0.001), AST levels (MD=-9.68, 95%CI -11.36 to -8.01, P<0.001), ALT levels (MD=﹣21.24, 95%CI -34.81 to -7.68, P=0.002), TBiL levels (SMD=-0.70, 95%CI -0.95 to -0.45, P<0.001), CRP levels (SMD=-0.52, 95%CI -0.91 to -0.13, P=0.009), procalcitonin levels (MD=-0.19, 95%CI -0.32 to -0.05, P=0.006), IL-6 levels (MD=-7.30, 95%CI -14.26 to -0.33, P=0.04), and the first flatus time (MD=-1.16, 95%CI -1.51 to -0.82, P<0.001), hospital stay(MD=-0.62, 95%CI -0.83 to -0.41, P<0.001), hospitalisation costs (SMD=-0.65, 95%CI -0.95 to -0.34, P<0.001) were lower.

Conclusion  Current evidence shows that perioperative oral probiotics can significantly reduce the postoperative infection rate and decrease the release of inflammatory factors in liver resection patients, promote the recovery of postoperative hepatic and gastrointestinal functions, and shorten the length of hospital stay and costs. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

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