Jaundice Clinical Trial
Official title:
Effectiveness of Perioperative Symbiotic Therapy to Reduce Infectious Morbidity in Jaundiced Patients: a Randomized Controlled Trial
The aim of the present study was therefore to evaluate if the perioperative administration of symbiotics reduces postoperative infectious morbidity in jaundiced patients scheduled for hepato-biliary and pancreatic surgery.
Despite advances in preoperative patient's selection and anesthetic and surgical techniques,
surgery in jaundiced patients is associated with significant morbidity and mortality as a
consequence of septic complications. The evidence that nosocomial infections are frequently
a consequence of gut-derived organism such as enterobacteriaceae, supports the hypothesis of
the "gut derived sepsis". Indeed, several studies have reported that jaundiced patients
present an increased intestinal permeability and consequently a higher rate of bacterial
migration from gastrointestinal tract across the lamina propria to local mesenteric lymph
nodes and from there to extra-intestinal site. This phenomenon increases after surgical
decompression of bile duct. The higher prevalence of bacterial translocation in jaundiced
patients is related to different mechanisms such as mucosal atrophy secondary to protracted
absence of intraluminal bile that open para-cellular route for bacterial translocation and
the decreased clearance capacity of Kuppfer secondary to cholestasis.
The mechanisms of action of symbiotics are largely unknown. The probiotic bacteria can
improve the mucosal barrier function reducing the bacterial translocation of organism to
mesenteric lymph nodes. Indeed symbiotic can affect the intestinal ecosystem by stimulating
mucosal immune and non-immune mechanisms through antagonism/competition with potential
pathogens.
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Observational Model: Case Control, Time Perspective: Prospective
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