This study evaluated the effect of intra-amniotic synbiotic inclusion and continued synbiotic supplementation in the diet on the performance, intestinal epithelium integrity, and cecal microflora of broiler chickens. In Experiment 1, 510 eggs containing viable embryos were divided into 3 groups of 170 eggs each. The first group was not injected and served as a negative control ( NC: ). The next group was injected with 0.9% NaCl and was the positive control ( PC: ). The synbiotic-injected group ( S: ) was injected with a 0.5% inulin and 1 × 10 Enterococcus faecium solution. The non-injected and synbiotic injected groups were further divided into 2 sets for Experiment 2 and the birds were offered either a basal or synbiotic supplemented diet (1% inulin and 2 × 10 E. faecium cfu/kg feed). One hundred ninety-six broiler hatchlings were randomly allocated in a 2 × 2 factorial arrangement that included an intra-amniotic treatment (non-injected or synbiotic injected) and a dietary treatment (basal or synbiotic supplemented diet). The results showed that the administration of an intra-amniotic synbiotic to embryonated eggs on d 17 of incubation did not affect the hatchability or hatching weight of the birds. However, intra-amniotic synbiotic inclusion had a positive effect on FCR at d 0 to 42 (P = 0.041) and d 22 to 42 (P = 0.036). There was no significant interaction effect on the growth performance of the birds between the intra-amniotic and dietary synbiotic treatment during different or entire experimental periods. Villus height and goblet and proliferating cell nuclear antigen ( PCNA: ) positive cell counts were positively influenced by intra-amniotic and dietary synbiotic treatments. Our results also indicated that intra-amniotic synbiotic injection followed by dietary supplementation with a synbiotic significantly increased Lactobacillus colonization and decreased coliform population in the broiler cecum. Cecal butyric acid concentration increased proportionally to the cecal Lactobacillus count with dietary synbiotic supplementation on d 42. In summary, combined intra-amniotic and dietary synbiotic treatments improved broiler intestinal integrity and increased cecal beneficial bacteria populations.

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Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.

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