Bacterial translocation in patients undergoing pancreatic surgery and the influence of
prophylactic use of probiotics and selective decontamination of the digestive tract in
a randomized placebo-controlled trial
Diepenhorst G.M.P.1, van Ruler O.2, Besselink M.G.H.3, van Santvoort H.C.3, Wijnandts P.R. 4, Gouma
D.J.2, Gooszen H.G.3, Boermeester M.A.2
(1) Department of Surgery (Surgical Laboratory), Academic Medical Center, and Department of
Immunopathology, Sanquin Research, Amsterdam, The Netherlands
(2) Department of Surgery, Academic Medical Center, Amsterdam, and Dutch Acute Pancreatitis Study
Group, Utrecht, The Netherlands
(3) Departments of Surgery, University Medical Center Utrecht and Dutch Acute Pancreatitis
Study Group, Utrecht, The Netherlands
(4) Department of Anaesthesiology, Academic Medical Center, The Netherlands
Objective: We aimed to assess bacterial translocation (BT) and the subsequent local inflammatory
response in patients undergoing major abdominal surgery. Moreover, the effect on peri-operative gut
barrier function of the administration of probiotics and selective decontamination of the digestive tract
(SDD) was compared to standard treatment. Background: BT describes the passage of
gastrointestinal microbiota across the intestinal mucosal barrier to local mesenteric lymph nodes
(MLNs) and ultimately to other organs. The process is suggested to play a major role in the
development of postoperative infections in patients undergoing major abdominal surgery. However, its
exact mechanism and clinical significance remain to be established. Methods: This randomized
controlled multicenter trial included 30 consecutive patients planned for elective pylorus preserving
pancreatico-duodenectomy receiving peri-operative probiotics, SDD or standard treatment. To assess
intestinal barrier function, Intestinal Fatty Acid Binding Protein (I-FABP) and polyethylene glycol (PEG)
recovery in urine were measured peri-operatively. Peroperative BT was assessed by real-time
polymerase chain reaction (q-PCR) and Multiplex ligation-dependent probe amplification (MLPA) in
mesenteric lymph nodes (MLNs) harvested early (baseline control) and late during the operation.
Results: When combining all treatment groups, bacterial DNA was detected in 18 out of 27 of late
MLNs as compared to 13 out of 23 of control MLNs by PCR. Probiotics and SDD showed no
significant effect on the number of positive MLNs. MLPA analysis of MLNs indicated a significant peroperative increase in expression of 12/30 inflammatory mediator-related genes (P<0.05), whereas
none of the genes demonstrated a decrease in expression levels. Intestinal permeability was
unaffected by surgery as well as by probiotics and SDD as compared to standard treatment.
Conclusion: This study suggests that BT and its subsequent inflammatory response after major
elective abdominal surgery may be part of physiological antigen-sampling processes of the gutassociated lymphoid tissue. Administration of probiotics and SDD did not alter the prevalence of BT or
intestinal permeability, and seem unlikely candidates for prophylactic clinical use in this setting.