Synbiotics: Potential to Improve Infection-Related Outcomes in Pancreatic Surgery

When patients need pancreatic surgery, surgeons worry about postoperative infections with good reason. Even with strict adherence to infection control technique, ideal surgical procedures, perfect perioperative care, and aggressive antibiotic prophylaxis, morbidity and mortality from infection remains high. Researchers from Korea and India have published a study in the Annals of Surgery indicating synbiotics (combined probiotics and probiotics) may improve recovery in pancreatic surgery patients.

Surgical candidates are at elevated risk for intestinal microflora disturbance due to decreased postoperative intestinal motility, jaundice, antibiotics usage, impaired mucosal barrier function, immune suppression and operative trauma. These researchers looked at perioperative synbiotic therapy’s effect on postoperative infectious complications, morbidity and mortality in patients undergoing pancreatic surgery for chronic pancreatitis.

This study enrolled 79 patients with chronic calcific pancreatitis undergoing Frey's procedure, and 75 completed the entire study. Patients in the treatment arm (n=39) took a synbiotic combination (Streptococcus faecalis, Clostridium butyricum, Bacillus mesentericus, Lactobacillus sporogenes, and fructooligosaccharides) 3 times day for 15 days starting 5 days before surgery. Patients in the control arm (n=36) took a placebo. The researchers monitored postoperative infection during the first 30 days. They also tracked mortality, length of hospital stay, days in intensive care unit, and duration of antibiotic therapy.

Patients in the treatment arm were significantly less likely to develop postoperative infectious complications. Only 12.8% of symbiotic-treated patients developed infections compared to 39% in the control group.

Patients in the treatment arm received antibiotics for a mean of 2.4 days compared to 10.8 day in the control group. Length of stay was also significantly shorter in the treatment arm (8 days) compared to the control arm (18 days).

Although more studies are needed to confirm these findings, symbiotic therapy is a simple, inexpensive intervention that may reduce morbidity and mortality significantly.