Rayes N et al. (2007) Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind trial. Ann Surg 246: 36–41

Enteral nutrition supplemented with synbiotics can reduce the incidence of bacterial infections and the duration of antibiotic therapy after pylorus-preserving pancreatoduodenectomy, according to the results of a new study by Rayes et al.

In this randomized, prospective, double-blind, single-center study, 40 patients received a synbiotic composition (four lactic acid bacteria plus four bioactive fibers) and 40 received placebo (fibers only) from preoperative day 1 until postoperative day 8. All patients received a single preoperative intravenous shot of antibiotics, and PPIs and enteral nutrition postoperatively throughout the study period. Additional antibiotics were administered as required. Risk factors for the development of infection were similar for both groups.

Compared with the placebo group, during the first 30 postoperative days, the synbiotic group required a shorter duration of antibiotic therapy (P = 0.015) and developed fewer bacterial infections (P = 0.005). Patients in the synbiotic group also developed less severe infections than those in the placebo group. In addition, although not statistically significant, the mean length of hospital stay and time spent in intensive care were shorter for the synbiotic group than for the placebo group. The synbiotic composition was well tolerated. Side effects caused by the enteral nutrition (e.g. diarrhea) and noninfectious complications (e.g. leakage of the pancreatic anastomosis) occurred in a similar number of patients in both groups.

This work adds to the clinical experience of using probiotics and prebiotics in surgical patients, for whom, in the case of pancreatic resection, postoperative infection rates can be high.