Perioperative Synbiotics Decrease Postoperative Complications in Periampullary Neoplasms: A Randomized, Double-Blind Clinical Trial

Periampullary neoplasms are rapidly progressive tumors with a poor prognosis and high morbidity and mortality rates, which have a negative influence on patient outcomes. Some probiotics and prebiotics have the ability to protect the intestinal barrier and prevent bacterial translocation, infection, and postoperative complications. We evaluated the use of synbiotics in a prospective, double-blind study of patients undergoing surgery for periampullary neoplasms (PNs) and assessed the effect of these agents on nutritional status, postoperative complications, antibiotic use, length of hospital stay, and mortality. Patients were randomized to receive probiotics and prebiotics-synbiotics-group S [Lactobacillus acidophilus 10, 1 x 10(9)CFU, Lactobacillus rhamnosus HS 111, 1 x 10(9) CFU, Lactobacillus casei 10, 1 x 10(9) CFU, Bifidobacterium bifidum, 1 x 10(9)CFU, and fructooligosaccharides (FOS) 100mg]-or placebo-controls-group C, twice daily, for a total of 14days. Risk, clinical status, and postoperative complication rates were assessed. Twenty-three patients were allocated to each group. The incidence of postoperative infection was significantly lower in group S (6 of 23 patients, 26.1%) than in group C (16 of 23 patients, 69.6%) (P= 0.00). Duration of antibiotic therapy was also shorter in group S (mean = 9days vs. 15days in group C; P= 0.01). Noninfectious complications were less common in group S (6 of 23vs. 14 of 23 patients in group C; P= 0.03). Mean length of hospital stay was 12 +/- 5days in group S vs. 23 +/- 14days in group C (P= 0.00). No deaths occurred in group S, whereas 6 deaths occurred in group C (P= 0.02). Perioperative administration of synbiotics reduces postoperative mortality and complication rates in patients undergoing surgery for PNs.