title: Synbiotics in Surgery for Chronic Pancreatitis: Are They Truly Effective? A Single-blind Prospective Randomized Control Trial.
abstract: BACKGROUND
  Postoperative infectious complications in patients undergoing pancreatic surgery are a significant cause for morbidity and mortality. Although synbiotics have beneficial effects on human health, their clinical value in surgical patients remains unclear given a paucity of applicable clinical studies.
  
  
  OBJECTIVE
  To determine the impact of perioperative synbiotic therapy on postoperative infectious complications, morbidity and mortality in patients undergoing pancreatic surgery for chronic pancreatitis.
  
  
  METHODS
  A trial was conducted in patients with chronic calcific pancreatitis undergoing Frey's procedure. Group A received a specific synbiotic composition, 5 days prior and 10 days after the surgery. Group B received a placebo. Primary study endpoint was the occurrence of postoperative infection during the first 30 days. Secondary outcome measures were mortality, length of hospital stay, days in intensive care unit, and duration of antibiotic therapy. Using previously accrued data, with α of 0.05 and power 80%, the sample size was calculated as 35 patients for each group with a dropout rate of 10%.
  
  
  RESULTS
  Of the 79 patients enrolled, 75 completed the trial [group A (n = 39) and group B (n = 36)]. The incidence of postoperative infectious complications (12.8% vs 39%; P < 0.05), duration of antibiotics therapy (P < 0.05), and length of hospital stay (P < 0.05) were significantly lower in the synbiotic group.
  
  
  CONCLUSIONS
  Synbiotics significantly reduce septic complications, hospital stay, and antibiotic requirement in patients undergoing pancreatic surgery for chronic pancreatitis. Furthermore, basic and clinical research would clarify the underlying mechanisms of their therapeutic effect and define the appropriate conditions for use.
authors.affiliation: From the Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Chennai, India.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Rammohan
authors.forename: Jeswanth
authors.initials: J
authors.lastname: Sathyanesan
authors.forename: Kamalakannan
authors.initials: K
authors.lastname: Rajendran
authors.forename: Anbalagan
authors.initials: A
authors.lastname: Pitchaimuthu
authors.forename: Senthil Kumar
authors.initials: SK
authors.lastname: Perumal
authors.forename: Kesavan
authors.initials: K
authors.lastname: Balaraman
authors.forename: Ravi
authors.initials: R
authors.lastname: Ramasamy
authors.forename: Ravichandran
authors.initials: R
authors.lastname: Palaniappan
authors.forename: Manoharan
authors.initials: M
authors.lastname: Govindan
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010193:Pancreaticojejunostomy / Q000009:adverse effects* / Q000379:methods; D050500:Pancreatitis, Chronic / Q000601:surgery*; D011446:Prospective Studies; D016037:Single-Blind Method; D058616:Synbiotics