Effects of Lactobacillus rhamnosus GG on early postoperative outcome after pylorus-preserving pancreatoduodenectomy: a randomized trial.

OBJECTIVE: Pancreatoduodenectomy (PPPD) remains one of the most complex surgical procedures with high complication rates. Infectious complications, postoperative ileus and delayed gastric emptying in the perioperative period have a significant impact on the recovery from the treatment. Probiotics (PB) are known to have a beneficial effect as supportive therapy in major abdominal surgery but the evidence in pancreatic surgery is still limited. The aim of the study was to assess the influence of postoperative administration of PB on the early outcomes after PPPD.

PATIENTS AND METHODS: Forty patients undergoing pylorus-preserving PPPD were enrolled to prospective trial and randomized in two groups: A - control group (n=20) receiving standard nutrition and B - probiotic group (n=20) treated additionally with Lactobacillus rahmnosus GG (L. rhamnosus GG) in the postoperative period from the day of the surgery for 30 days. Gastrointestinal motility, infection complications, length of hospital stay, and mortality were compared in the perioperative period and during 2 follow-up (i.e., after 14 and 30 days).

RESULTS: There were no significant differences in mortality and infectious complications between groups. The length of hospital stay was shorter in the probiotic group compared to control (10 days vs. 8, respectively). The positive effect of L. rhamnosus GG on gastrointestinal tract's motility was observed, including earlier recurrence of postoperative bowel movements (group B: after 3.75 days vs. group A: 2.15 days), passing gasses (group B after 4 days vs. group A 2.9 days) and the first postoperative stool (group B after 5.84 days vs. group A 3.85 days). L. rhamnosus GG improved the appetite in postoperative day 1, 3, 5, 7 and 30 days after the surgery.

CONCLUSIONS: L. rhamnosus GG improves the function of the gastrointestinal tract after major pancreatic surgery and may reduce the length of hospital stay.