Incidence Of Postoperative Infectious Complications Research Articles

Prevention of Inflammatory Complications upon Surgeries in Maxillofacial Region

Conducting of prophylactic antibiotic therapy in patient after surgical interventions in oral and maxillofacial surgery reduces the incidence of postoperative infectious complications. The analysis of the clean, conditionally clean, dirty (potentially infected), and purulent surgeries is performed. The general questions of prophylaxis of infection complications in plastic, orthognathic, purulent surgeries, and oral microflora are considered. Consecutive cases of postoperative complications and purulent conditions at the head and neck areas are presented. Recommendations on the antibiotic prophylaxis in oral and maxillofacial surgery are given.

Timing of antimicrobial prophylaxis and infectious complications in pediatric patients undergoing appendectomy

PurposeAntibiotic administration within one hour prior to incision is a common quality metric; however, antibiotics are typically started at the time of diagnosis in pediatric patients with acute appendicitis. The purpose was to determine if antibiotic administration within one hour prior to incision reduces the incidence of surgical site infections (SSI) in pediatric patients with acute appendicitis started on parenteral antibiotics upon diagnosis. MethodsA retrospective review was performed of 478 patients aged 0–18years who underwent appendectomy for acute appendicitis from 7/2013 to 4/2015. Patients were categorized based on timing of antibiotic administration; there were 198 patients in Group A (<60min before) and 280 in Group B (>60min before). ResultsDemographics and operative time (A: 30.5±9.9 vs B: 30.8±12.2min, p=0.51) were similar. Procedures were performed laparoscopically and the groups had similar proportions of single-incision operations (A: 53% vs B: 55%, p=0.64). There was no difference in the incidence of superficial SSI (A: 2.0% vs B: 2.1%, p=1.0) or intraabdominal abscess (A: 4.0% vs B: 3.6%, p=0.81) and this remained true when stratified by intraoperative classification. ConclusionAntibiotic administration within one hour of appendectomy in pediatric patients with acute appendicitis who receive antibiotics at diagnosis did not change the incidence of postoperative infectious complications. Type of studyTreatment study. Level of evidenceIII.

Reducción de la morbilidad postoperatoria en el cáncer colorrectal programado: inmunonutrición oral preoperatoria

PurposeAssess the efficacy of preoperative administration of oral immunonutrition in patients with resectable colorectal cancer, in terms of reducing the incidence of postoperative infectious complications. Material and methodsProspective randomized study. A total of 84 patients were recruited. To the group YES IN, Impact© Oral was preoperatively administered for 8 days (3 bricks a day), whereas the NOT IN group only received normal diet, without supplements. ResultsOf all patients, 40.5% (17) in the NOT IN group suffered infectious complications against 33.3% (14) in the YES IN group. Among patients with rectal cancer in the NOT IN group, 50% (8) suffered minor infectious complications, compared with 13.6% (3) among those in the YES IN group (P=.028). Using logistic regression, the variable total protein on the fifth postoperative day [OR: 2.8 (95% CI: 1.3 to 6.3) (P=.012)] showed a statistically significant relationship with the occurrence of infectious complications. Specifically, anastomotic leak variable behaved as a risk factor in the development of surgical site infection, with an OR of 4.5 (95% CI: 1.3 to 16.1) (P=.033). DiscussionMalnutrition in cancer patients suitable for surgery results in an increase in postoperative morbidity and mortality. The use of enteral formulas with immunonutrients in these subjects can attenuate this morbidity, decreasing infectious complications. ConclusionIn our analysis, the NOT IN group suffered more postoperative infectious complications, particularly the subset of patients with rectal cancer.

C-Reactive Protein Was an Early Predictor of Postoperative Infectious Complications After Pancreaticoduodenectomy for Pancreatic Cancer

Objective The study objective was to assess the predictive value of C-reactive protein (CRP) for the early detection of postoperative infectious complications (PICs) after pancreaticoduodenectomy. Summary of Background Data The incidence of PICs after pancreaticoduodenectomy still remains high and a clinically relevant problem, despite improvements in the surgical procedure. Methods We examined 110 consecutive patients who underwent pancreaticoduodenectomy for primary pancreatic cancer between 2006 and 2014. The predictive value was assessed by estimating the area under the receiver operating characteristic curve (AUC). Clinical and laboratory data, including CRP, were analyzed with univariate and multivariate logistic regression analyses to identify predictors of PICs of grade III or higher according to the Clavien-Dindo classification. Results PICs of grade III or higher occurred in 13 patients [11.8%; 95% confidence interval (CI), 6.45%–19.36%]. CRP level on postoperative day 3 (POD 3) was a good predictor of PICs (AUC, 0.815; 95% CI, 0.651–0.980), showing the highest accuracy among clinical and laboratory data. A cutoff value of 13.2 mg/dL yielded a sensitivity of 0.846 and a specificity of 0.794. On multivariate analysis, a POD 3 CRP level of 13.2 mg/dL or higher (odds ratio, 20.0; 95% CI, 4.07–97.9; P = 0.002) was a significant predictor of PICs after pancreaticoduodenectomy. Conclusions CRP elevation above 13.2 mg/dL on POD 3 is a significant predictive factor for PICs and should prompt an intense clinical search and therapeutic approach for PICs.

135 - Rectal culture-guided targeted antimicrobial prophylaxis significantly reduces the incidence of post-operative infectious complications in men at high risk for infections submitted to transrectal ultrasound prostate biopsy – results of a cross-sectional study

135 - Rectal culture-guided targeted antimicrobial prophylaxis significantly reduces the incidence of post-operative infectious complications in men at high risk for infections submitted to transrectal ultrasound prostate biopsy – results of a cross-sectional study

50: The incidence of postoperative infectious complications in hysterectomy for benign indications

50: The incidence of postoperative infectious complications in hysterectomy for benign indications

The influence of neoadjuvant chemotherapy on gastric cancer patients' postoperative infectious complications: What is the negative role played by the intestinal barrier dysfunction?

Evidence has shown that neoadjuvant chemotherapy (NACT) is correlated with patients’ overall postoperative complications. But investigations on relationship between NACT and postoperative infectious complications, which is closely linked to intestinal barrier damage, were scanty. Accordingly, 90 patients with advanced gastric cancer were included in this study. The differences in postoperative infectious complications were determined between NACT group in which patients received NACT before surgery and SURG group in which received surgical treatment immediately after diagnosis. The damage of mechanical structure of intestinal barrier was assessed by hematoxylin and eosin staining, transmission electron microscopy, and immunohistochemistry. Mucosal microbiota changes were determined by using a 16S rRNA gene sequencing approach. Results showed that the incidence of postoperative infectious complications were significantly higher in the NACT group. Tight junctions were disrupted, and claudin-1, ZO-1 and occludin were down-regulated in patients with infectious complications in overall compared with those without. And similarly, the patients in the NACT group also showed damaged intestinal barrier compared with those in SURG group. Besides, the total diversity of mucosal related bacteria was decreased and relative abundance of some probiotics, such as Bifidobacterium, Faecalibacterium and Ruminococcus, was reduced in the NACT group as well. In conclusion, our study identifies a higher incidence of postoperative infection in gastric cancer patients who underwent NACT treatment, and these changes might be caused by a significant damage in the intestinal barrier as well as reduced probiotics.

Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery.

Background.Hyperoxia has long been perceived as a desirable or at least an inevitable part of cardiopulmonary bypass. Recent evidence suggest that it might have multiple detrimental effects on patient homeostasis. The aim of the study was to identify the determinants of supra-physiological values of partial oxygen pressure during on-pump cardiac surgery and to assess the impact of hyperoxia on clinical outcomes.Materials and methods.Retrospective data analysis of the institutional research database was performed to evaluate the effects of hyperoxia in patients undergoing elective cardiac surgery with cardiopulmonary bypass, 246 patients were included in the final analysis. Patients were divided in three groups: mild hyperoxia (MHO, PaO2 100–199 mmHg), moderate hyperoxia (MdHO, PaO2 200–299 mmHg), and severe hyperoxia (SHO, PaO2 >300 mmHg). Postoperative complications and outcomes were defined according to standardised criteria of the Society of Thoracic Surgeons.Results.The extent of hyperoxia was more immense in patients with a lower body mass index (p = 0.001) and of female sex (p = 0.005). A significant link between severe hyperoxia and a higher incidence of infectious complications (p – 0.044), an increased length of hospital stay (p – 0.044) and extended duration of mechanical ventilation (p < 0.001) was confirmed.Conclusions.Severe hyperoxia is associated with an increased incidence of postoperative infectious complications, prolonged mechanical ventilation, and increased hospital stay.

The impact of fish oil (ω-3 fatty acids) intervention on infectious complications and cost-effectiveness for postoperative patients: systematic review (2010-2016)

Objective To evaluate the impact of fish oil (ω-3 fatty acids) parenteral nutrition (PN) on outcomes for non-ICU postoperative patients. Methods PubMed, Embase, Cochrane, China National Know-ledge Infrastructure (CNKI) and Wanfang Database etc. were searched to retrieve the eligible studies published from January 2010 to June 2016. The studies included were randomized controlled trials (RCTs) that evaluated the effects of supplementation of fish oil(Omegawen) in PN regimens for postoperative patients on clinical outcomes. The methodological quality assessment was based on Jadad scale and Schulz allocation concealment tool. Meta-analysis was conducted by RevMan 5.3 software. Results 19 RCTs, 1 170 surgical patients, were included. Meta-analysis indicated that short-term fish oil supplementation significantly reduced the incidence of infectious complications [RR=0.44, 95% CI (0.31, 0.64), P<0.000 1] and shortened the length of hospital stay [MD=-0.85, 95% CI (-1.67, -0.03), P=0.04], while with no significant effect on mortality [RR=0.42, 95% CI (0.07, 2.63), P=0.36] and total expenditure of hospitalization [MD=-216.60, 95% CI(-718.94, 285.75), P=0.40]. Sensitivity analysis showed similar results. Conclusion According to existing evidence, fish oil in PN for surgical patients could reduce the incidence of postoperative infectious com-plications and shorten the length of hospital stay. Key words: Fish oil; Fatty acids, Omega-3 fatty acid; Parenteral nutrition; Postoperative patients; Meta-analysis; Incremental cost-effectiveness

Influence of a Shorter Duration of Post-Operative Antibiotic Prophylaxis on Infectious Complications in Patients Undergoing Elective Liver Resection.

Antibiotic prophylaxis has been recommended to reduce post-operative infectious complications. Discontinuation of post-operative antibiotic administration within 24 hours of operation is currently recommended. Many surgeons, however, conventionally tend to extend the duration of prophylactic antibiotic use. In this study, we performed a retrospective analysis to assess the efficacy of extended post-operative antibiotic use in patients who underwent elective liver resection. A total of 208 consecutive patients who underwent liver resection without biliary reconstruction were investigated. Patients were divided into two groups according to the duration of post-operative antibiotic use: Only once after the operation (the post-operative day [POD] 0 group) and until three days after the operation (the POD 3 group). Post-operative complications in the two groups were analyzed and compared. Incisional surgical site infections (SSIs) were observed in 5% of the POD 0 group and 3% of the POD 3 group (p = 0.517). Organ/space SSIs were observed in 2% of the POD 0 group and 3% of the POD 3 group (p = 0.694). Overall infectious complications including SSIs and remote site infections were observed in 12% of the POD 0 group and 11% of the POD 3 group. Multi-variable analyses revealed that the short-term post-operative antibiotic regimen did not confer additional risk for infectious complications. In elective liver resection, the administration of prophylactic antibiotics on the operative day alone appears to be sufficient, because no additional benefit in the incidence of post-operative infectious complications was conferred on patients given antibiotic agents for three days.

Povidone-iodine rectal cleansing and targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound-guided prostate biopsy are associated with reduced incidence of postoperative infectious complications.

The aim of this study was to evaluate the effect of povidone-iodine rectal disinfection and targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound-guided prostate biopsy based on rectal swab culture results. From January 2011 to December 2015, we studied differences in infectious complications in men who received povidone-iodine rectal disinfection with targeted antimicrobial prophylaxis and those who received empirical prophylaxis before transrectal ultrasound-guided prostate biopsy. Clinical variables including demographics, prior antibiotic, rectal swab culture results, povidone-iodine rectal cleansing, antibiotic prophylaxis, and infectious complications were evaluated. Patients were divided into three groups as follows: Group A received no povidone-iodine rectal cleansing but received empirical antimicrobial prophylaxis; group B received povidone-iodine rectal cleansing and empirical antimicrobial prophylaxis; and group C received povidone-iodine rectal cleansing and targeted antimicrobial prophylaxis. Patients were divided into group A (n=192; 13.2%), group B (n=579; 39.9%), or group C (n=679; 46.8%). In groups A and B, all patients received fluoroquinolone antimicrobial prophylaxis. Group C patients received targeted antimicrobial prophylaxis according to antibiotic resistance of rectal flora, and 71.1% of these received fluoroquinolone antimicrobial prophylaxis. Infectious complication rates were 3.6, 2.9, and 1.3% in group A, group B, and group C, respectively. Incidences of acute prostatitis and bacteremia were significantly lower in group C (p=0.041 and p=0.049, respectively) than in the other groups. In the era of quinolone resistance, the combination of povidone-iodine rectal cleansing and targeted antibiotic prophylaxis may reduce the rate of infectious complications.

Perioperative ω-3 Polyunsaturated Fatty Acid Nutritional Support in Gastrointestinal Cancer Surgical Patients: A Systematic Evaluation

ABSTRACTThis study was a systematic evaluation of the beneficial effects of n-3 polyunsaturated fatty acid (PUFA) in abdominal cancer surgical patients. A literature search of the databases PubMed, Medline, Cochrane, and EMBASE was conducted for studies published up to November 2014 in English language journals. Randomized controlled trials (RCTs) examining the effects of n-3 PUFA intake relative to conventional nutrition in surgical patients were included. The main outcomes were the duration of systemic inflammatory response syndrome (SIRS), length of hospital stay (LOS), serum C-reactive protein (CRP) levels, and postoperative complications. We identified 15 RCTs among 158 relevant trials. The results indicated the associations between n-3 PUFA intake and reduced LOS [mean differences (MDs), −2.47 d; 95% confidence intervals (CIs), −3.25 to −1.69], duration of SIRS (MD, −0.57 d; 95% CI, −0.92 to −0.22), and serum CRP levels (MD, −3.97 mg/l; 95% CI, −7.88 to −0.07) compared with consumption of conventional nutrition, as well as reduced incidence of postoperative infectious complications (risk ratio, 0.66; 95% CI, 0.49–0.87). This systematic evaluation suggests that n-3 PUFA significantly reduces the postoperative infectious complication rate, and shortens hospitalization and SIRS duration, particularly in malnourished gastrointestinal cancer patients.

36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016.

36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016.

Low fat-containing elemental formula is effective for postoperative recovery and potentially useful for preventing chyle leak during postoperative early enteral nutrition after esophagectomy

Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery. A total of 74 patients who received TTE-3FL for esophageal cancer were retrospectively examined. Patients were classified into two groups according to the type of postoperative EN: Group LF patients received a low-fat elemental formula, and Group F patients received a standard fat-containing polymeric formula. The following clinical factors were compared between the groups: EN start day, maximum EN calories administered, duration of respirator use, length of ICU stay, incidence of postoperative infectious complications, use of parenteral nutrition (PN), and incidence of postoperative chyle leak. Patients in Group LF were started on EN significantly earlier after surgery and they consumed significantly higher maximum EN calories compared to Group F patients (P<0.01). Duration of respirator use and length of ICU stay were also significantly shorter, and TPN was used significantly less in Group LF compared to Group F (P<0.05). Postoperative chyle leak was observed in six patients in total (8.1%); five patients in Group F and one patient in Group LF, although there was no significant difference in frequency of chyle leak per patient between Group LF and Group F. Early EN using low-fat elemental formula after esophagectomy with three-field lymphadenectomy was safe and valid for postoperative recovery and potentially useful in preventing chyle leak.

Postoperative Infectious Complications are Associated with Adverse Oncologic Outcomes in Esophageal Cancer Patients Undergoing Preoperative Chemotherapy.

For some types of cancer, postoperative complications can negatively influence survival, but the association between these complications and oncological outcomes is unclear for patients with esophageal cancer who receive preoperative treatments. Data were retrospectively analyzed for patients who underwent curative resection following preoperative chemotherapy for esophageal squamous cell carcinoma from 2001 to 2011. Clinicopathological parameters and cancer-specific survival (CSS) were compared between patients with and without severe postoperative complications, grade III or higher, using the Clavien-Dindo classification. Of 255 patients identified, 104 (40.8%) postoperatively developed severe complications. The most common complication was atelectasis in 61 (23.9%), followed by pulmonary infection in 22 (8.6%). Three-field lymphadenectomy, longer operation time, and more blood loss were significantly associated with a higher incidence of severe complications. Multivariate analysis of CSS revealed severe complications [hazard ratio (HR)=1.642, 95% confidence interval (95% CI) 1.095-2.460, p=0.016] as a significant prognostic factor along with pT stage [HR=2.081, 95% CI 1.351-3.266, p<0.001] and pN stage [HR=3.724, 95% CI 2.111-7.126, p<0.001], whereas postoperative serum C-reactive protein value was not statistically significant. Among all complications, severe pulmonary infection was the only independent prognostic factor [HR=2.504, 95% CI 1.308-4.427, p=0.007]. The incidence of postoperative infectious complications, in particular pulmonary infection, is associated with unfavorable prognosis in patients with esophageal cancer undergoing preoperative chemotherapy.

Perioperative supplementation with bifidobacteria improves postoperative nutritional recovery, inflammatory response, and fecal microbiota in patients undergoing colorectal surgery: a prospective, randomized clinical trial.

The use of probiotics has been widely documented to benefit human health, but their clinical value in surgical patients remains unclear. The present study investigated the effect of perioperative oral administration of probiotic bifidobacteria to patients undergoing colorectal surgery. Sixty patients undergoing colorectal resection were randomized to two groups prior to resection. One group (n=31) received a probiotic supplement, Bifidobacterium longum BB536, preoperatively for 7–14 days and postoperatively for 14 days, while the other group (n=29) received no intervention as a control. The occurrences of postoperative infectious complications were recorded. Blood and fecal samples were collected before and after surgery. No significant difference was found in the incidence of postoperative infectious complications and duration of hospital stay between the two groups. In comparison to the control group, the probiotic group tended to have higher postoperative levels of erythrocytes, hemoglobin, lymphocytes, total protein, and albumin and lower levels of high sensitive C-reactive proteins. Postoperatively, the proportions of fecal bacteria changed significantly; Actinobacteria increased in the probiotic group, Bacteroidetes and Proteobacteria increased in the control group, and Firmicutes decreased in both groups. Significant correlations were found between the proportions of fecal bacteria and blood parameters; Actinobacteria correlated negatively with blood inflammatory parameters, while Bacteroidetes and Proteobacteria correlated positively with blood inflammatory parameters. In the subgroup of patients who received preoperative chemoradiotherapy treatment, the duration of hospital stay was significantly shortened upon probiotic intervention. These results suggest that perioperative oral administration of bifidobacteria may contribute to a balanced intestinal microbiota and attenuated postoperative inflammatory responses, which may subsequently promote a healthy recovery after colorectal resection.

PERIOPERATIVE PROGRAMMED DEATH 1 EXPRESSION ON CD4+ T CELLS PREDICTS THE INCIDENCE OF POSTOPERATIVE INFECTIOUS COMPLICATIONS.

Programmed death 1 (PD-1) has been reported to be an immunoinhibitory receptor expressed by chronically stimulated T cells after T-cell activation. The present study was designed to evaluate the relationship between perioperative PD-1 expression on CD4 T cells and the incidence of postoperative infectious complications in patients undergoing gastroenterological surgery. One hundred one patients with gastroenterological disease were enrolled in this study. Blood samples were taken on the preoperative day (Pre) and the first postoperative day (POD1). We calculated the CD4 T-cell count and the PD-1 expression on CD4 T cells via flow cytometry. Postoperative infectious complications occurred in 30 of the 101 patients. The CD4 T-cell count was significantly lower in the patients who developed postoperative infectious complications at POD1 compared with the patients who did not. In addition, the PD-1 expression on CD4 T cells was significantly higher at Pre or POD1 in the patients who developed postoperative infectious complications. The preoperative PD-1 expression on CD4 T cells was found to be independently associated with postoperative infectious complications according to multivariate analysis. The perioperative CD4 T-cell count or PD-1 expression on CD4 T cells may be early predictive markers for the development of postoperative infectious complications.

Effect of statins on preventing infectious complications after surgery: Systematic review and meta-analysis.

*These authors contributed equally to this work.A meta-analysis to investigate the association between preoperative statin use and the risk of postoperative infectious complications in patients undergoing surgery. PubMed(®) and Embase(®) databases were searched for relevant studies. Data were extracted using a standardized data collection form. The primary effect measure was the odds ratio (OR) of postoperative infectious complications. Summary OR were calculated. The analysis included 10 cohort studies with a total of 147 263 participants. Statin use was associated with a lower incidence of postoperative infectious complications in all studies (summary OR 0.917, 95% confidence intervals [CI] 0.862, 0.975, fixed-effects model; summary OR 0.731, 95% CI 0.584, 0.870, random-effects model); cardiac surgery (summary OR 0.673; 95% CI 0.535, 0.847); treatment in the USA (summary OR 0.678; 95% CI 0.597, 0.770); retrospective cohort studies (summary OR 0.664; 95% CI 0.521, 0.846). Preoperative statin use is associated with a reduced risk of postoperative infectious complications.

Immunonutrition Support for Patients Undergoing Surgery for Gastrointestinal Malignancy: Preoperative, Postoperative, or Perioperative? A Bayesian Network Meta-Analysis of Randomized Controlled Trials.

Enteral immunonutrition (EIN) has been established to be as a significantly important modality to prevent the postoperative infectious and noninfectious complications, enhance the immunity of host, and eventually improve the prognosis of gastrointestinal (GI) cancer patients undergoing surgery. However, different support routes, which are the optimum option, remain unclear. To evaluate the effects of different EIN support regimes for patients who underwent selective surgery for resectable GI malignancy, a Bayesian network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted. A search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was electronically searched until the end of December 2014. Moreover, we manually checked reference lists of eligible trials and review and retrieval unpublished literature. RCTs which investigated the comparative effects of EIN versus standard enteral nutrition (EN) or different EIN regimes were included if the clinical outcomes information can be extracted from it. A total of 27 RCTs were incorporated into this study. Pair-wise meta-analyses suggested that preoperative (relative risk [RR], 0.58; 95% confidence interval [CI], 0.43-0.78), postoperative (RR, 0.63; 95% CI, 0.52-0.76), and perioperative EIN methods (RR, 0.46; 95% CI, 0.34-0.62) reduced incidence of postoperative infectious complications compared with standard EN. Moreover, perioperative EIN (RR, 0.65; 95% CI, 0.44-0.95) reduced the incidence of postoperative noninfectious complications, and the postoperative (mean difference [MD], -2.38; 95% CI, -3.4 to -1.31) and perioperative EIN (MD, -2.64; 95% CI, -3.28 to -1.99) also shortened the length of postoperative hospitalization compared with standard EN. NMA found that EIN support effectively improved the clinical outcomes of patients who underwent selective surgery for GI cancer compared with standard EN. Our results suggest EIN support is promising alternative for operation management in comparison with standard EN, and perioperative EIN regime is the optimum option for managing clinical status of patients who underwent selective surgery for GI cancer.

Synbiotics in Surgery for Chronic Pancreatitis

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. To determine the impact of perioperative synbiotic therapy on postoperative infectious complications, morbidity and mortality in patients undergoing pancreatic surgery for chronic pancreatitis. 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%. 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. 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.