Effect of Perioperative Synbiotic Treatment on Bacterial Translocation and Postoperative Infectious Complications after Pancreatoduodenectomy
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Updated: Mar 24, 2026
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Published on: March 15, 2024
Yukihiro Yokoyama1, Takashi Miyake, Toshio Kokuryo
1Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Background/Aims:
This study investigated the effect of perioperative synbiotics on bacterial translocation to mesenteric lymph nodes (MLNs) and occurrence of infectious complications following pancreatoduodenectomy (PD; University Hospital Medical Information Network ID 000003705).
Methods:
Patients who were scheduled to undergo PD were randomized to receive preoperative synbiotics or no synbiotics (control group). MLNs were harvested at laparotomy (MLN-1) and after the resection (MLN-2). Blood samples were collected before laparotomy (Blood-1) and on postoperative day 1 (Blood-2). Microorganisms in each sample were detected using a bacterium-specific ribosomal RNA-targeted reverse transcriptase-quantitative polymerase chain reaction.
Results:
Forty-four patients were included. In all samples, the bacterial detection rate in the MLN-1, MLN-2, Blood-1, and Blood-2 was lower in the synbiotics group than in the control group, although it did not reach a statistically significant difference. There was a significant correlation between the positivity of bacteria in the MLN-2 and Blood-2 samples (p = 0.009). The incidence rate of overall infectious complications was not significantly different between the 2 groups. Among various perioperative factors, the incidence of pancreatic fistula was the only factor that had a significant association with the incidence of infectious complications.
Conclusion:
The preoperative use of synbiotics did not affect the incidence of infectious complications following PD.
Insights
Perioperative synbiotics did not significantly reduce bacterial translocation or infectious complications after pancreatoduodenectomy (PD). Further research is needed to explore the role of synbiotics in surgical outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Microbiology
Background:
- Pancreatoduodenectomy (PD) carries a risk of infectious complications.
- Bacterial translocation is a potential contributor to post-surgical infections.
- Perioperative interventions aim to mitigate these risks.
Purpose of the Study:
- To investigate the impact of preoperative synbiotics on bacterial translocation to mesenteric lymph nodes (MLNs).
- To assess the effect of synbiotics on the occurrence of infectious complications following PD.
- To evaluate the correlation between bacterial presence and infectious outcomes.
Main Methods:
- Randomized controlled trial comparing synbiotics versus placebo in PD patients.
- Collection of mesenteric lymph node (MLN) and blood samples at defined perioperative time points.
- Quantitative polymerase chain reaction (qPCR) used for bacterial detection in biological samples.
Main Results:
- Lower bacterial detection rates observed in MLN and blood samples from the synbiotics group, though not statistically significant.
- A significant correlation was found between bacterial presence in MLN-2 and Blood-2 samples (p = 0.009).
- No significant difference in the overall incidence of infectious complications between synbiotics and control groups.
Conclusions:
- Preoperative synbiotics administration did not significantly alter bacterial translocation or reduce infectious complications post-PD.
- Pancreatic fistula emerged as a significant predictor of infectious complications.
- The current evidence does not support the routine use of synbiotics to prevent infections after PD.
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