Probiotic and Prebiotic Use in Early Postoperative Period of Sleeve Gastrectomy

The Effect of Probiotic and Prebiotic Use on Gastrointestinal System and Some Biochemical Parameters in the Early Postoperative Period of Sleeve Gastrectomy Patients

This randomized controlled clinical study investigates the effects of daily synbiotic supplementation (containing Lactobacillus rhamnosus GG and partially hydrolyzed guar gum) in patients who underwent sleeve gastrectomy. 60 participants aged 18-65 with a BMI of 35 or higher were randomly assigned to intervention (n=30) and control (n=30) groups. The intervention group received a 5 g sachet daily for 12 weeks postoperatively, mixed into 200 ml of yogurt and consumed during afternoon snacks. The control group received no supplementation. Anthropometric measurements, biochemical parameters, and gastrointestinal outcomes were assessed at baseline, week 4, and week 12. The aim is to evaluate the influence of probiotic and prebiotic supplementation on gastrointestinal function and biochemical markers in the early postoperative period following bariatric surgery.

Obesity is a growing global health problem, and bariatric surgery particularly sleeve gastrectomy, has become an effective method for long-term weight management. However, postoperative gastrointestinal changes, dysbiosis, and metabolic adaptations remain significant challenges, especially during the initial recovery period. The gut microbiota plays a critical role in digestion, nutrient absorption, immune modulation, and metabolic regulation. Probiotics and prebiotics may contribute to restoring microbial balance, enhancing intestinal barrier integrity, and improving biochemical profiles following surgery.

This randomized controlled trial was designed to evaluate the impact of synbiotic supplementation on gastrointestinal symptoms and selected biochemical parameters in patients undergoing sleeve gastrectomy. A total of 60 patients aged 18 to 65 years, with a body mass index (BMI) of 35 or higher, were enrolled. Participants were randomly assigned to two groups in a 1:1 ratio. The intervention group (n = 30) received a 5 g sachet containing maltodextrin (4.9 g) and Lactobacillus rhamnosus GG (1×10⁹ CFU) in a partially hydrolyzed guar gum matrix, administered once daily mixed into 200 ml of yogurt for 12 weeks postoperatively. The control group (n = 30) received no supplementation.

In the early postoperative period, patients commonly experience gastrointestinal symptoms such as bloating, gas, and constipation. This study aims to determine whether synbiotic supplementation can alleviate these symptoms and positively affect gastrointestinal function, anthropometric measurements, and specific biochemical markers. Additionally, it explores participants' knowledge and awareness of microbiota-related concepts, including probiotics and prebiotics. Data were collected through validated questionnaires assessing gastrointestinal symptoms, constipation severity, dietary habits, and microbiota-related knowledge. Anthropometric and biochemical assessments were conducted at baseline and at weeks 4 and 12 postoperatively.

Inclusion Criteria:

• Voluntary participation (provided informed consent)
• Age between 18 and 65 years
• Body mass index (BMI) ≥ 35 kg/m²
• Underwent laparoscopic sleeve gastrectomy

Exclusion Criteria:

• Use of antibiotics for more than 5 days after surgery
• Antibiotic use within 6 months prior to surgery
• Use of any prebiotic or probiotic supplement within 3 months prior to surgery
• Known intolerance to prebiotics or probiotics
• Use of immunosuppressive drugs or NSAIDs
• Diagnosed with liver or kidney failure
• Age under 18 or over 65
• History of cholecystectomy or scheduled simultaneous cholecystectomy with sleeve gastrectomy
• Lactose intolerance
• Presence of early postoperative complications (e.g., bleeding, persistent vomiting, fistula, obstruction, leakage, infection, etc.)
• Diagnosed dumping syndrome after surgery
• Early postoperative food intolerance or dehydration
• Inability to undergo bioelectrical impedance analysis (e.g., pacemaker, metallic implants)
• Conditions affecting body composition analysis results, such as:
• Menstruation at the time of measurement
• Consumption of food or caffeinated beverages within 4 hours of measurement
• Intense physical activity within 48 hours of measurement
• Non-adherence to daily probiotic/prebiotic supplementation protocol during the intervention period Alcohol consumption within 48 hours of measurement