Efficacy of probiotics and selective decontamination of the digestive tract in reducing bacterial translocation in patients with pylorus preserving pancreaticoduodenectomy.

Postoperative infectious complications are mainly caused by the patient’s own gut flora. Both the use of enteral probiotics and selective decontamination of the digestive tract (SDD) have been described as succesfull techniques to reduce bacterial translocation and subsequent infectious complications.
- This study aims to quantify the effect of these techniques on the gut flora and the bacterial translocation.
Patients with pylorus preserving pancreaticoduodenectomy (PPPD) are studied because in these patients are a homogeneous group with major surgery may lead to postoperative impaired gastrointestinal motility and bacterial overgrowth.
A total of 30 adult patients who are planned to undergo a pylorus-preserving pancreaticoduodenectomy in the AMC Amsterdam or in the UMC Utrecht.
Preoperatively, excessive cholestasis has been drained, usually by ERCP.
- After informed consent, patients will be randomly assigned to 3 groups.
Group A (n=10) will receive probiotics.
Group B (n=10) will receive SDD.
Group C (n=10) will receive standard treatment.

All patients will receive standardized anesthesia and postoperative analgesia.
The effect of preoperative prophylaxis regimes can be assessed by bacterial counts in a small jejunal biopsy and an adjacent lymphnodes.
Also the effect of the prophylactic regimes on gut permeability, cytokine production and faecal flora will be assesed.

Perioperative administration of probiotics or SDD has an effect on small bowel bacterial overgrowth and bacterial translocation to lymph nodes in patients undergoing PPPD by protecting or enhancing bowel (mucosa) permeability.

N/A

Group A (n=10) will receive probiotics.
Group B (n=10) will receive SDD.

Group C (n=10) will receive standard treatment.