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Impact of perioperative enteral synbiotics in hepatic and pancreatic surgery: design and rationale of a single blind placebo controlled prospective randomised control trial
  1. Ashwin Rammohan,
  2. Jeswanth Sathyanesan,
  3. Kamalakannan Rajendran,
  4. Anbalagan Pitchaimuthu,
  5. Senthil Kumar Perumal,
  6. U P Srinivasan,
  7. Ravi Ramasamy,
  8. Ravichandran Palaniappan,
  9. Manoharan Govindan
  1. Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB diseases, Government Stanley Medical College Hospital, Chennai, India
  1. Correspondence to Dr Ashwin Rammohan, Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB diseases, Government Stanley Medical College Hospital, Old Jail Road, Chennai 600001, India; ashwinrammohan{at}gmail.com

Abstract

Background Prebiotics and probiotics influence all pathogenic mechanisms of bacterial translocation. Used in combination, they are called synbiotics. Postoperative infective complications in patients undergoing hepatic and pancreatic surgery lead to a significant prolongation of hospital stay and increased costs. While synbiotics are considered to have beneficial effects on human health, their clinical value in surgical patients, especially in South Asia remains unclear given a paucity of applicable clinical studies. In this study we aim to assess their clinical usefulness in patients who undergo hepatic and pancreatic surgery.

Methods A prospective monocentric randomised single blind controlled trial is being conducted in patients undergoing major pancreatic resections (Whipple procedure, distal pancreatectomy, Frey procedure) and hepatic resections. Group A received a specific synbiotic composition, 5 days prior and 10 days after the surgery. Group B received a placebo. Primary study end point was the occurrence of postoperative infection during the first 30 days. Secondary outcome measures were mortality, first bowel movement, days in intensive care unit, length of hospital stay, and duration of antibiotic therapy. Side effects of probiotics were evaluated. From previous studies we assumed that perioperative synbiotics reduce the proportion of patients with infectious complications from 50% to 12%, with α of 0.05 and power 80%, the calculated sample size was 35 patients for each group with a dropout rate of 10%.

Conclusions This study is intended at determining the impact of perioperative synbiotic therapy on postoperative infectious complications, morbidity and mortality in patients undergoing major pancreatic and hepatic surgery.

Clinical trial The Clinical Trials Registry of India (CTRI/2013/06/003737).

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