Authors: Nada Rayes, MD,* Daniel Seehofer, MD,* Tom Theruvath, MD,* Martina Mogl, MD,* Jan M. Langrehr, PhD,* Natascha C. Nu¨ssler, PhD,* Stig Bengmark, PhD,† and Peter Neuhaus, PhD*.
Published: Annals of Surgery, Volume 246, Number 1, July 2007.
The study was conducted in vivo, involving human participants.
Design: A prospective randomized monocentric double-blind trial.
Treatment: All patients received enteral nutrition immediately postoperatively. One group (A) received Synbiotic 2000 and another group (B) received placebo (the fibers only) starting the day before surgery and continuing for 8 days.
Where and when: Berlin, Germany.
Sample size: 80 patients.
Sample criteria: Adult patients undergoing pancreas resection (scheduled for PPPD, major abdominal surgery including liver transplantation). Exclusion criteria were decompensated renal insufficiencies and cerebral disorders with danger of aspiration, both contraindications for uninterrupted enteral nutrition.
Analysed material: Thirty-day infection rate, length of hospital stay, duration of antibiotic therapy, noninfectious complications, and side effects were recorded. (s. 36).
Results
The mean total length of hospital stay and the stay on intensive care unit were shorter in group A than in group B, but the difference was not statistically significant. The duration of antibiotic therapy (without prophylaxis) was significantly shorter in the patients receiving the synbiotic combination compared with those receiving fibers only (s 39).
40% receiving only the 4 fibers, developed bacterial infections. In contrast, 12.5% of patients in the group receiving the synbiotic combination developed bacterial infections. (s. 39).
Indicative results
In the study, early enteral nutrition combined with a synbiotic combination significantly reduced the incidence of bacterial nosocomial infections following PPPD compared with only fibers. (s39-40).
Early enteral nutrition supplemented with a mixture of LAB and fibers (Synbiotic) reduces bacterial infection rates and antibiotic therapy following PPPD. (s. 36).
Early enteral nutrition with Synbiotics was able to significantly reduce postoperative bacterial infections in patients following PPPD with only single-shot antibiotic prophylaxis. In contrast to antibiotics, it is relatively cheap and does not cause resistant strains or serious side effects. (s. 41).
By the time of this study, experimental and clinical experience with prebiotics and probiotics in surgical patients were limited. Whether a synbiotic combination is superior to a single probiotic strain was still needed to be discussed. An assumption is supported by findings from a randomized, placebo-controlled studies in liver transplant recipients with a similar design. (s.40).
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