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Effect of Enteral Nutrition and Synbiotics on Bacterial Infection Rates After Pylorus-preserving Pancreatoduodenectomy: A Randomized, Double-blind Trial

Rayes, Nada MD*; Seehofer, Daniel MD*; Theruvath, Tom MD*; Mogl, Martina MD*; Langrehr, Jan M. PhD*; Nüssler, Natascha C. PhD*; Bengmark, Stig PhD; Neuhaus, Peter PhD*

doi: 10.1097/01.sla.0000259442.78947.19
Randomized Controlled Trials

Objective: Patients undergoing pancreas resection carry several risk factors for nosocomial bacterial infections. Pre- and probiotics (synbiotics) are potentially useful for prevention of these infections.

Summary Background Data: First trials in patients following major abdominal surgery including liver transplantation using one Lactobacillus (LAB) and one fiber showed significant reduction of infection rates and reduced length of antibiotic therapy compared with a control group. The present study was designed to analyze whether a combination of different LAB and fibers would further improve outcome.

Methods: A prospective randomized monocentric double-blind trial was undertaken in 80 patients following pylorus-preserving pancreatoduodenectomy (PPPD). All patients received enteral nutrition immediately postoperatively. One group (A) received a composition of 4 LAB and 4 fibers, and another group (B) received placebo (fibers only) starting the day before surgery and continuing for 8 days. Thirty-day infection rate, length of hospital stay, duration of antibiotic therapy, noninfectious complications, and side effects were recorded.

Results: The incidence of postoperative bacterial infections was significantly lower with LAB and fibers (12.5%) than with fibers only (40%). In addition, the duration of antibiotic therapy was significantly shorter in the latter group. Fibers and LAB were well tolerated.

Conclusion: Early enteral nutrition supplemented with a mixture of LAB and fibers reduces bacterial infection rates and antibiotic therapy following PPPD.

Pre- and probiotics (synbiotics) are potentially useful for the prevention of postoperative bacterial infections. In a randomized, double-blind trial with 80 patients undergoing pancreas resection, a combination of synbiotics led to a significantly lower infection rate and reduction of antibiotic therapy compared with placebo.

From the *Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Humboldt University, Berlin, Germany; and the †Royal College of Surgeons, London, UK.

Reprints: Nada Rayes, MD, Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.